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Sample records for agammaglobulinemia

  1. Arthritis and X-linked agammaglobulinemia.

    Science.gov (United States)

    Machado, Pedro; Santos, Alexandra; Faria, Emília; Silva, Jorge; Malcata, Armando; Chieira, Celso

    2008-01-01

    Primary immunodeficiencies are defined as genetically determined functional and/or quantitative abnormalities in one or more of the components of the immune system. Immunodeficiency and arthritis can be related, although the mechanisms are not always clear. Different causes for immunodeficiency can secondarily be found in patients with arthritis; on the other hand, arthritis can be a manifestation of primary immunodeficiency. Arthritis occurs chiefly in humoral primary immunodeficiencies, namely in X-linked agammaglobulinemia and common variable immunodeficiency, and may be one of the warning signs for primary immunodeficiency. We report a case of arthritis as the presenting feature of X-linked agammaglobulinemia. In X-linked agammaglobulinemia, arthritis may be a consequence of infection, most notably by Mycoplasma, or of immune dysfunction itself. In children, and occasionally in young adults, a combination of arthritis and hypogammaglobulinemia should suggest primary immunodeficiency, although other causes of hypogammaglobulinemia must be excluded. Physicians evaluating patients with arthritis should be aware of this fact so that an early diagnosis can be pursued as it is of extreme importance in the optimal management and prognosis of these patients.

  2. Evolving practice: X-linked agammaglobulinemia and lung transplantation.

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    Barnes, S; Kotecha, S; Douglass, J A; Paul, E; Hore-Lacy, F; Hore-Lacey, F; Stirling, R; Snell, G I; Westall, G P

    2015-04-01

    X-linked agammaglobulinemia (XLA) is a rare primary humoral immunodeficiency syndrome characterized by agammaglobulinemia, recurrent infections and bronchiectasis. Despite the association with end-stage bronchiectasis, the literature on XLA and lung transplantation is extremely limited. We report a series of 6 XLA patients with bronchiectasis who underwent lung transplantation. Short-term outcomes were excellent however long-term outcomes were disappointing with a high incidence of pulmonary sepsis and chronic lung allograft dysfunction (CLAD).

  3. Neutropenia Associated with X-Linked Agammaglobulinemia

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    Aghamohammadi Asghar

    2009-03-01

    Full Text Available X-linked Agammaglobulinemia (XLA is a hereditary immunodeficiency, characterized by an early onset of recurrent bacterial infections, hypogammaglobulinemia and markedly reduced B lymphocytes number. In order to determine the association of neutropenia among Iranian patients with XLA, hospital records of 30 patients with confirmed XLA in Children Medical Center Hospital, were reviewed. Eight out of 30 XLA patients (26.7% developed neutropenia during the course of the disease. In two patients, episodes of neutropenia were identified before or at the time of diagnosis of XLA. Other six patients whom were not visited regularly and did not receive periodical immunoglobulin replacement therapy experienced neutropenia after diagnosis of XLA. Neutropenia in XLA is mainly associated with infection and is resolved with intravenous immunoglobulin replacement and antibiotics therapy.

  4. A case of Fabry's disease with congenital agammaglobulinemia.

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    Lee, Ki-Yeol; Jeon, Su-Young; Hong, Jin-Woo; Kim, Sung-Eun; Song, Ki-Hoon; Kim, Young-Hun; Kim, Ki-Ho

    2011-07-01

    Fabry's disease is an X-linked lysosomal storage disorder caused by abnormalities in the α-galactosidase A (GLA) gene, which leads to a GLA deficiency and to the intracellular deposition of globotriaosylceramide (Gb3) within vascular endothelium and other tissues. It manifests as progressive multiple organ dysfunctions caused by the deposition of Gb3. On the other hand, congenital agammaglobulinemia is usually caused by mutations in Bruton's tyrosine kinase (Btk) gene with X-linked dominence, suppresses B cell maturation, and causes recurrent pyogenic infections. In former reports, the distance between the loci in the Xq22 region of the human X chromosome was found to be about 69 kilobases. A 23-yr-old man diagnosed with congenital agammaglobulinemia at age 5, showed typical clinical and laboratory and histopathological findings of Fabry's disease. The genetic basis of this combination of the two syndromes was studied in this patient. Here, we report a case of Fabry's disease with congenital agammaglobulinemia.

  5. JOINT DISEASE IN CHILDREN WITH X-LINKED AGAMMAGLOBULINEMIA

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    Lidija Kareva

    2013-11-01

    Full Text Available Patients with X-linked agammaglobulinemia (XLA are prone to recurrent bacterial infections due to low levels of immunoglobulins. Clinical symptoms include recurrent bacterial otitis media, bronchitis, pneumonia, meningitis, skin infection and arthritis.In the majority of cases arthritis can be shown to be caused by infection, but also aseptic arthritis and autoimmune diseases may be present. Monoarthritis and oligoarthritis is usual pattern, although polyarthritis may occur. This paper presents diagnostic and therapeutic problems in our patients with agammaglobulinemia and arthritis.

  6. Clinical patterns of X linked agammaglobulinemia in Malaysian children.

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    Noh, L M; Ismail, Z; Zainudin, B M; Low, S M; Azizi, B H; Noah, R M; Nasaruddin, B A

    1995-06-01

    X linked agammaglobulinemia (XLA) is rarely reported from developing countries especially from South East Asia. It appears that X linked agammaglobulinemia is less common in certain ethnic groups. It is very uncommon in black people in USA and South Africa. In multiracial Malaysia we have documented five XLA in Malays and Indians but not in the Chinese that constitute about 31% of the population. First degree relatives afflicted with XLA or other primary immunodeficiencies occurred more often in our study. All showed lung involvement although the etiologic organisms involved were atypical, being Gram negative.

  7. X-Linked agammaglobulinemia in a child with Klinefelter's syndrome.

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    Cochino, Alexis-Virgil; Janda, Ales; Ravcukova, Barbora; Plaiasu, Vasilica; Ochiana, Diana; Gherghina, Ioan; Freiberger, Tomas

    2014-02-01

    Bruton's agammaglobulinemia is a rare X-linked humoral immunodeficiency manifesting with recurrent bacterial infections early in life. Klinefelter's syndrome caused by an additional X chromosome is the most common sex chromosome disorder. A previously unreported association of these two conditions is described here.

  8. Multiple colorectal neoplasms in X-linked agammaglobulinemia

    NARCIS (Netherlands)

    Brosens, Lodewijk A. A.; Tytgat, Kristien M. A. J.; Viorsink, Folkert H. M.; Sinke, Richard J.; Ten Berge, Ineke J. N.; Giardiello, Francis M.; Offerhaus, G. Johan A.; Keller, Josbert J.

    2008-01-01

    X-linked agammaglobulinemia (XLA) is a primary immunodeficiency disorder caused by germline mutation of the Bruton tyrosine kinase (BTK) gene. It is characterized by disturbed B-cell development, decreased immunoglobulin levels, and increased patient susceptibility to infection. An increased risk of

  9. Membranoproliferative Glomerulonephritis and X-Linked Agammaglobulinemia: An Uncommon Association

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    Vasco Lavrador

    2014-01-01

    Full Text Available Introduction. X-linked agammaglobulinemia (XLA is a primary immunodeficiency characterized by agammaglobulinemia requiring replacement treatment with immunoglobulin. The association of XLA and membranoproliferative glomerulonephritis (MPGN is unexpected and, to our knowledge, only one case was previously published. Case Report. The authors report the case of a 10-year-old boy with family history and prenatal diagnosis of XLA, treated from birth with intravenous immunoglobulin replacement therapy. He presented with pneumonia, macroscopic hematuria, nephrotic proteinuria, hypoalbuminemia, and hypercholesterolemia with normal renal function and serum complement levels. Renal histology showed immune complex mediated MPGN. He was started on high dose prednisolone and ramipril and switched to weekly subcutaneous immunoglobulin. After a 4-month treatment, hematuria and proteinuria significantly improved and prednisolone was gradually tapered without relapse. Conclusion. The pathogenic process underlying MPGN development in this patient is unknown but residual humoral immunity might play an important role. Thus, this case highlights the risk of autoimmune disorders among patients with XLA.

  10. Agammaglobulinemia: causative mutations and their implications for novel therapies.

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    Berglöf, Anna; Turunen, Janne J; Gissberg, Olof; Bestas, Burcu; Blomberg, K Emelie M; Smith, C I Edvard

    2013-12-01

    Agammaglobulinemias are primary (inherited) immunodeficiencies characterized by the lack of functional B-cells and antibodies, and are caused by mutations in genes encoding components of the pre-B-cell or B-cell receptor, or their signaling pathways. The known genetic defects do not account for all agammaglobulinemic patients, suggesting that novel mutations underlying the disease remain to be found. While efficient, the current life-maintaining therapy with immunoglobulins and antibiotics is non-curative, prompting research into alternative treatment strategies that aim at rescuing the expression of the affected protein, thus giving rise to functional B-cells. These include gene therapy, which could be used to correct the defective gene or replace it with a functional copy. For a number of genetic defects, another alternative is to modulate the splicing of the affected transcripts. While these technologies are not yet ready for clinical trials in agammaglobulinemia, advances in genomic targeting are likely to make this option viable in the near future.

  11. Prevalence of BTK mutations in male Algerian patterns with agammaglobulinemia and severe B cell lymphopenia.

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    Boushaki, Soraya; Tahiat, Azzedine; Meddour, Yanis; Chan, Koon Wing; Chaib, Samia; Benhalla, Nafissa; Smati, Leila; Bensenouci, Abdellatif; Lau, Yu-Lung; Magdinier, Frédérique; Djidjik, Réda

    2015-12-01

    X linked agammaglobulinemia (XLA) is the first described primary immunodeficiency and the most common form of agammaglobulinemia. It is characterized by susceptibility to recurrent infections, profound decrease of all immunoglobulin isotypes and very low level of B lymphocytes in peripheral blood. The disorder is caused by mutations in the Bruton's Tyrosine Kinase (BTK). Nine male patients suspected to have XLA from nine unrelated families were enrolled in this study. We performed sequencing of the BTK gene in all nine patients, and in the patients' relatives when possible. The XLA diagnosis was confirmed for six patients with six different mutations; we identified a novel mutation (c.1522G>A) and five known mutations. One third of nine unrelated patients do not have mutations in BTK and thus likely suffer from autosomal recessive agammaglobulinemia in the setting of consanguinity. Our results support that the autosomal recessive agammaglobulinemia can be more common in Algeria.

  12. Autosomal recessive agammaglobulinemia: a novel non-sense mutation in CD79a.

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    Khalili, Abbas; Plebani, Alessandro; Vitali, Massimiliano; Abolhassani, Hassan; Lougaris, Vassilios; Mirminachi, Babak; Rezaei, Nima; Aghamohammadi, Asghar

    2014-02-01

    This study describes the fifth case worldwide of autosomal recessive agammaglobulinemia due to a novel non-sense mutation in CD79a gene with a severe unusual onset due to an invasive central nervous system infection.

  13. Casereport - Agalactia of mare, agammaglobulinemia and arthritis in foal

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    Spasojević Jovan

    2014-01-01

    Full Text Available Lactation is physiological state of the organism and the final process of the female reproductive cycle. Milk in the first days after birth (colostrum, in addition to the necessary nutrients contains antibodies, with whose ingesting only a newborn individual receives passive immunity that protects it from various infections over time. Mammary gland dysfunction and a lack of breast milking is called agalactia. Due to the occurrence of agalactia in mother, newborn animal is denied of intake of colostrum in its body. Thus prevents ingestion of nutrients and passive immunity, which results in the occurrence of various diseases especially infectious etiology. This paper describes the treatment of agammaglobulinemia in foal after ascertaining the occurrence of primary agalactia in mare. There is described the possibility of substitution, ie. benefits of breast milk substitutes, and the procedure of diagnosis and treatment of carpal arthritis in foal.

  14. Dermatomyositis-like syndrome in x-linked agammaglobulinemia

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    Pedro David Carvalho

    2016-01-01

    Full Text Available Primary immunodeficiencies (PIDs encompass more than 250 different pathological conditions. X-linked agammaglobulinemia (XLA has been occasionally associated with cutaneous and muscular manifestations resembling dermatomyositis, often termed dermatomyositis-like syndrome (DLS. This syndrome has been associated with cutaneous, muscular and central nervous system manifestations, accompanying a persistent infection by an Echovirus. According to sixteen previously reported cases, this syndrome has a poor prognosis. We report the case of a 27-years old male, with XLA and DLS, successfully treated with 6 cycles of human immunoglobulin and methotrexate. Clinical symptoms improved dramatically with a complete resolution of the musculoskeletal manifestations. Despite this clinical response, prognosis should remain reserved. The evolution of this syndrome remains unpredictable and therapeutic options are limited. To the best of our knowledge, there are only a few reports of similar cases which have survived so many months after the diagnosis.

  15. X linked agammaglobulinemia: a single centre experience from India.

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    Merchant, Rashid H; Parekh, Deep; Ahmad, Noor; Madkaikar, Manisha; Ahmed, Javed

    2014-01-01

    The authors report a series of seven cases of X-linked Agammaglobulinemia, diagnosed and receiving treatment at a tertiary care centre in Mumbai. The ages of the patients ranged from 15 mo to 15 y. After diagnosis at a mean age of 3 ½ y, all were advised intravenous immunoglobulin (IvIg) infusion therapy in doses of 400-600 mg/kg every 3-4 wk. They were followed up for an average duration of 9 y, throughout which the complications and overall response to immunoglobulin therapy have been observed. The clinical profiles of each of these cases were retrospectively analysed with respect to age at diagnosis, frequency and severity of infections before and after initiation of treatment, co-morbidities and response to therapy. The results demonstrate the importance of early diagnosis and its correlation with decreased complications.

  16. X-linked Agammaglobulinemia With Normal Immunoglobulin and Near-Normal Vaccine Seroconversion.

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    Preece, Kahn; Lear, Graeme

    2015-12-01

    We present a 22-month-old boy with X-linked agammaglobulinemia masked by normal immunoglobulin levels and vaccine seroconversion. Diagnosis was made after strong clinical suspicion of immune deficiency led to identification of markedly reduced B-cell numbers and confirmation with identification of a novel Bruton tyrosine kinase gene mutation. He was commenced on replacement immunoglobulin therapy with excellent clinical improvement. This case highlights the variability of phenotypic presentation and apparent disunity between routine immunologic investigations and severe disease in X-linked agammaglobulinemia, necessitating clinical acumen to make the diagnosis.

  17. Shulman disease (eosinophilic fasciitis) in X-linked agammaglobulinemia.

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    Pituch-Noworolska, A; Mach-Tomalska, H; Szaflarska, A; Adamek, D

    2016-06-01

    X-linked agammaglobulinemia (XLA) diagnosed in the first year of life is an immunodeficiency with a life-long indication for substitution of immunoglobulins, due to lack of B lymphocytes in the periphery. The decrease of bacterial infection frequency and severity is an effect of immunoglobulin replacement. However, in the majority of patients bronchiectasis and chronic sinusitis with an overgrown mucous membrane develop despite regular substitution. Autoimmune diseases as co-existing diseases in XLA are noted in a few patients presenting symptoms associated with arthritis, scleroderma and myositis. Our patient was diagnosed with XLA in the first year of life, followed by regular substitution of immunoglobulins. The symptoms of pain, edema of muscles of the right shank with skin edema and discoloration after mild injury were noted in a 13-year-old boy. Shulman disease was diagnosed after 6 months of symptoms, based on histopathology of muscle and skin biopsy. Before the diagnosis, non-steroid anti-inflammatory drugs (NSAID) were used with a transient effect. After the diagnosis, therapy included steroids, immunoglobulins in a high dose and immunosuppression, with improvement of clinical symptoms. During methotrexate (MTX) therapy the patient developed two episodes of pneumonia, so mycophenolate mofetil (MMF) was used, with a similar effect. Now, with this therapy, the symptoms are mild and stable without progression.

  18. [X-linked agammaglobulinemia in adults. Clinical evolution].

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    Giorgetti, Orlando B; Paolini, María V; Oleastro, Matías M; Fernández Romero, Diego S

    2016-01-01

    X-linked agammaglobulinemia (XLA) is characterized by absent or severely reduced B cells, low or undetectable immunoglobulin levels and clinically by extracellular bacterial infections which mainly compromise the respiratory tract as well as recurrent diarrheas. The mainstay of treatment is gammaglobulin replacement therapy, which allows most patients to reach adulthood with high quality of life. We analyzed the clinical features of 14 patients over 18 years of age with XLA diagnosis that received treatment in our unit from the year 2003, the date the first patient was derived, until 2015. The average age at which patients were referred was 20.4 years old; age at the last consult was 25.5. The average follow-up time was 59.8 months. Previously to being diagnosed all patients had suffered infections, most frequently respiratory. After diagnosis all were started on intravenous gammaglobulin replacement treatment and in spite of infections being reduced in severity and frequency, there were cases of severe disease with long term sequelae. At the beginning of our follow-up 35.7% presented impaired respiratory function with only one case being severe. In no cases during this period did the respiratory function worsen, nor were there severe clinical complications. Three patients were switched to subcutaneous immunoglobulin treatment with good tolerance. The number of XLA cases is increasing, as most reach the second decade of life without serious complications and remain free of severe infectious disease and further impairment of their respiratory functions with the treatment.

  19. T lymphocytes and NK cells in X-linked agammaglobulinemia.

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    Pituch-Noworolska, Anna; Zwonarz, Katarzyna; Błaut-Szlósarczyk, Anita; Szaflarska, Anna; Kowalczyk, Danuta; Siedlar, Maciej

    2013-01-01

    Seven boys with diagnosis of X-linked agammaglobulinemia on regular substitution of immunoglobulins were included into study. The patients showed episodes of infections but the clinical course was mild with good response to antibiotics. All patients developed, with time, the chronic sinusitis with proliferation of mucous membrane, two patients showed bronchiectases. The number of T lymphocytes, ratio of CD4:CD8 subpopulations, response to stimulation and NK number were assayed with flow cytometry and cell culture. Results showed CD4:CD8 ratio within normal value in majority of patients, reverse ratio in 2 boys, increased number of activated T cells (CD3/HLA-DR) in one of them. The number of NK cells was different from lack of these cells to high number. Response of T cells to stimulation (mitogens and CD3) were normal in majority of assays. There were no associations between clinical course and observed changes in T or NK cell populations. Further studies on number and function of NK cells are needed.

  20. Discordant phenotype in siblings with X-linked agammaglobulinemia

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    Bykowsky, M.J.; Veksler, K.S.; Sullivan, K.E. [Children`s Hospital, Philadelphia, PA (United States)] [and others

    1996-03-01

    X-linked agammaglobulinemia (XLA) is a congenital humoral immunodeficiency caused by a defect in a B-cell-specific signaling molecule, Btk. There has been little concordance of phenotype with genotype in this disorder, and defects in Btk cause immunodeficiencies that range from mild impairment to complete inability to produce antibodies. The factors modifying the phenotype of XLA are not understood. The current study is the first description of two male siblings with identical T{sup 134}{yields}C mutations in the translation initiation ATG of Btk who have different clinical phenotypes as well as different laboratory phenotypes. The proband lacks immunoglobulins and B cells and has recurrent infections, while the elder, affected brother has normal levels of IgG and IgM and very few infections. Both have undetectable levels of Btk kinase activity in circulating mononuclear cells. Complete sequencing of Btk gene transcripts in both brothers revealed no additional mutations to account for the discordant phenotypes. This description provides unequivocal evidence that the phenotype of XLA is influenced by factors additional to the Btk gene. 39 refs., 3 figs., 3 tabs.

  1. Successful approach to treatment of Helicobacter bilis infection in X-linked agammaglobulinemia.

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    Turvey, Stuart E; Leo, Sara H; Boos, Annette; Deans, Gregory D; Prendiville, Julie; Crawford, Richard I; Senger, Christof; Conley, Mary Ellen; Tilley, Peter; Junker, Anne; Janz, Loretta; Azana, Robert; Hoang, Linda; Morton, Tracy L

    2012-12-01

    Helicobacter bilis, an unusual cause of chronic infections in patients with X-linked agammaglobulinemia (XLA), is notoriously difficult to diagnose and eradicate. Based on the limited number of cases reported worldwide, we highlight the typical features of H. bilis infection in XLA and provide a rational and successful approach to diagnosis and treatment of this challenging infection.

  2. Pseudomonas aeruginosa septic shock associated with ecthyma gangrenosum in an infant with agammaglobulinemia

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    ALMEIDA João Fernando Lourenço de; Jaques SZTAJNBOK; Troster,Eduardo Juan; Vaz,Flávio Adolfo Costa

    2002-01-01

    Ecthyma gangrenosum (EG) due to Pseudomonas aeruginosa is a rare and invasive infection that can be associated with agammaglobulinemia. The cornerstone of the treatment is based on prompt recognition with appropriate antibiotic coverage and intravenous immunoglobulin. The authors report a case of EG emphasizing the clinical and therapeutic aspects of this condition.

  3. Pseudomonas aeruginosa septic shock associated with ecthyma gangrenosum in an infant with agammaglobulinemia

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    ALMEIDA João Fernando Lourenço de

    2002-01-01

    Full Text Available Ecthyma gangrenosum (EG due to Pseudomonas aeruginosa is a rare and invasive infection that can be associated with agammaglobulinemia. The cornerstone of the treatment is based on prompt recognition with appropriate antibiotic coverage and intravenous immunoglobulin. The authors report a case of EG emphasizing the clinical and therapeutic aspects of this condition.

  4. Splice-correcting oligonucleotides restore BTK function in X-linked agammaglobulinemia model

    DEFF Research Database (Denmark)

    Bestas, Burcu; Moreno, Pedro M D; Blomberg, K Emelie M;

    2014-01-01

    X-linked agammaglobulinemia (XLA) is an inherited immunodeficiency that results from mutations within the gene encoding Bruton's tyrosine kinase (BTK). Many XLA-associated mutations affect splicing of BTK pre-mRNA and severely impair B cell development. Here, we assessed the potential of antisense...

  5. Clinical characteristics and molecular analysis of 21 Chinese children with congenital agammaglobulinemia.

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    Zhang, Z-Y; Zhao, X-D; Jiang, L-P; Liu, E-M; Wang, M; Yu, J; Liu, P; Yang, X-Q

    2010-11-01

    Congenital agammaglobulinemia is a humoral primary immunodeficiency and affected patients have extremely low levels of peripheral B cells and profound deficiency of all immunoglobulin isotypes. Mutations of the Bruton's tyrosine kinase (BTK) gene are responsible for most of the congenital agammaglobulinemia. In this study, the phenotypes of congenital agammaglobulinemia were investigated in 21 male children from 21 unrelated Chinese families. Sixteen different mutations of BTK gene were identified in 18 patients, and three patients did not have BTK gene mutations. Nine mutations had been reported previously including one gross deletion (c.722_2041del), one missense mutation (c.1764G>T), three non-sense mutations (c.194C>A, c.895C>T and c.1821G>A) and four invariant splice-site mutations (c.971+2T>C, c.1481+2T>A, c.1482-2A>G, c.1699-2A>G). Seven novel mutations were identified (c.373_441del, c. 504delG, c.537delC, c.851delA, c.1637G>A, c.1879T>C and c. 1482_1882 del). Ten of the eighteen mutations of BTK gene were located in the TK domain, four in the PH domain, three in the SH3 domain and one spanned the TH, SH3, SH2 and TK domain. Candidate genes of autosomal-recessive agammaglobulinemia, including IGHM, CD79a, CD79b and IGLL1, were screened in three patients without mutations in the BTK gene. A compound heterozygosity mutation in the IGHM gene (c.1956G>A, c.175_176insC) was identified in one patient. The results of our study further support that molecular genetic testing represents an important tool for early confirmed diagnosis of congenital agammaglobulinemia and may allow accurate carrier detection and prenatal diagnosis.

  6. Application of carrier testing to genetic counseling for X-linked agammaglobulinemia

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    Allen, R.C.; Nachtman, R.G.; Belmont, J.W.; Rosenblatt, H.M.

    1994-01-01

    Bruton X-linked agammaglobulinemia (XLA) is a phenotypically recessive genetic disorder of B lymphocyte development. Female carriers of XLA, although asymptomatic, have a characteristic B cell lineage-specific skewing of the pattern of X inactivation. Skewing apparently results from defective growth and maturation of B cell precursors bearing a mutant active X chromosome. In this study, carrier status was tested in 58 women from 22 families referred with a history of agammaglobulinemia. Primary carrier analysis to examine patterns of X inactivation in CD19[sup +] peripheral blood cells (B lymphocytes) was conducted using quantitative PCR at the androgen-receptor locus. Obligate carriers of XLA demonstrated >95% skewing of X inactivation in peripheral blood CD19[sup +] cells but not in CD19[sup [minus

  7. Successful hematopoietic cell transplantation in a patient with X-linked agammaglobulinemia and acute myeloid leukemia.

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    Abu-Arja, Rolla F; Chernin, Leah R; Abusin, Ghada; Auletta, Jeffery; Cabral, Linda; Egler, Rachel; Ochs, Hans D; Torgerson, Troy R; Lopez-Guisa, Jesus; Hostoffer, Robert W; Tcheurekdjian, Haig; Cooke, Kenneth R

    2015-09-01

    X-linked agammaglobulinemia (XLA) is a primary immunodeficiency characterized by marked reduction in all classes of serum immunoglobulins and the near absence of mature CD19(+) B-cells. Although malignancy has been observed in patients with XLA, we present the first reported case of acute myeloid leukemia (AML) in a patient with XLA. We also demonstrate the complete correction of the XLA phenotype following allogeneic hematopoietic cell transplantation for treatment of the patient's leukemia.

  8. Autoimmunity in X-linked agammaglobulinemia: Kawasaki disease and review of the literature.

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    Behniafard, Nasrin; Aghamohammadi, Asghar; Abolhassani, Hassan; Pourjabbar, Sarvenaz; Sabouni, Farah; Rezaei, Nima

    2012-02-01

    Although autoimmunity phenotype is surprisingly common in patients with different types of primary antibody deficiency, it is much less frequent in X-linked agammaglobulinemia (XLA). Herein, we report on a 15-month-old boy with XLA who also suffered from Kawasaki disease. The current case presentation is the first report of an association between Kawasaki disease and XLA. XLA could be considered as a special opportunity to understand autoimmunity in the near absence of immunoglobulins.

  9. A recurrent dominant negative E47 mutation causes agammaglobulinemia and BCR(-) B cells.

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    Boisson, Bertrand; Wang, Yong-Dong; Bosompem, Amma; Ma, Cindy S; Lim, Annick; Kochetkov, Tatiana; Tangye, Stuart G; Casanova, Jean-Laurent; Conley, Mary Ellen

    2013-11-01

    Approximately 90% of patients with isolated agammaglobulinemia and failure of B cell development have mutations in genes required for signaling through the pre–B cell and B cell receptors. The nature of the gene defect in the majority of remaining patients is unknown. We recently identified 4 patients with agammaglobulinemia and markedly decreased numbers of peripheral B cells. The B cells that could be detected had an unusual phenotype characterized by the increased expression of CD19 but the absence of a B cell receptor. Genetic studies demonstrated that all 4 patients had the exact same de novo mutation in the broadly expressed transcription factor E47. The mutant protein (E555K) was stable in patient-derived EBV-transformed cell lines and cell lines transfected with expression vectors. E555K in the transfected cells localized normally to the nucleus and resulted in a dominant negative effect when bound to DNA as a homodimer with wild-type E47. Mutant E47 did permit DNA binding by a tissue-specific heterodimeric DNA-binding partner, myogenic differentiation 1 (MYOD). These findings document a mutational hot-spot in E47 and represent an autosomal dominant form of agammaglobulinemia. Further, they indicate that E47 plays a critical role in enforcing the block in development of B cell precursors that lack functional antigen receptors.

  10. Bruton’s agammaglobulinemia in an adult male due to a novel mutation: a case report

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    Xu, Yuanda; Qing, Qi; Liu, Xuesong; Chen, Sibei; Chen, Ziyi; Niu, Xuefeng; Tan, Yaxia; He, Weiqun; Liu, Xiaoqing; Li, Yimin

    2016-01-01

    X-linked agammaglobulinemia (XLA) is caused by mutation in the gene coding for Bruton’s tyrosine kinase (BTK), which impairs peripheral B cell maturation and hypogammaglobulinemia. In this report, we present a case of XLA in a 22-year-old adult male. Genetic testing revealed a novel mutation located at the conserved region (c.383T>C). The patient had a history of recurrent respiratory tract infection which eventually progressed to chronic type II respiratory failure. Several pathogenic bacteria were isolated on culture of respiratory secretions obtained on bronchoscopy. The patient improved on treatment with antibiotics. PMID:27867589

  11. A Child with X-Linked Agammaglobulinemia and Enthesitis-Related Arthritis

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    Sukesh Sukumaran

    2011-01-01

    Full Text Available X-linked agammaglobulinemia (XLA is a primary immune deficiency characterized by recurrent bacterial infections and profoundly depressed serum immunoglobulin levels and circulating mature B cells. We describe a 12-year-old boy with XLA and enthesitis-related arthritis (ERA. To date, there has been a paucity of reports of noninfectious inflammatory arthritis in children with XLA. This case illustrates that functional B cells and/or immunoglobulin are not required for ERA pathogenesis. In addition, this case suggests a possible link between immune deficiency, immune dysregulation, and rheumatic illness.

  12. Progressive neurodegenerative syndrome in a patient with X-linked agammaglobulinemia receiving intravenous immunoglobulin therapy.

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    Sag, Aslihan Taskiran; Saka, Esen; Ozgur, Tuba Turul; Sanal, Ozden; Ayvaz, Deniz Cagdas; Elibol, Bulent; Kurne, Asli Tuncer

    2014-09-01

    A progressive encephalopathy of unknown etiology has been described in patients with primary immunodeficiency disorders. In this report, we characterize the clinical features of this progressive neurodegenerative dementing disorder in a young man with Bruton agammaglobulinemia, through neuropsychological tests and a video sequence. The clinical course of the encephalopathy seems rather uniform: Cognition, especially frontal lobe function, is affected in the early stages, and some patients develop movement disorders. The syndrome causes severe cognitive and physical disability, and can eventually be fatal. The autoimmunity results from dysregulated immune responses, but the underlying mechanism has not yet been fully explained.

  13. Transient myelodysplastic syndrome in X-linked agammaglobulinemia with a novel Btk mutation.

    Science.gov (United States)

    Narula, Gaurav; Currimbhoy, Zinet

    2008-12-01

    X-linked agammaglobulinemia (XLA) is a rare disorder in which recurrent infections occur due to low serum globulins and circulating B lymphocytes caused by a mutation in the Bruton tyrosine kinase (Btk) gene. While myelodysplastic syndrome (MDS) associated with low B lymphocyte counts has been described, clonal cytogenetic abnormalities in confirmed cases of XLA have never been reported. We describe a case of XLA with a novel Btk mutation who also had a persistent clonal population in the bone marrow with abnormal cytogenetics in multiple chromosomes that resolved 1(1/2) years after treatment with IVIG, mimicking a picture of transient MDS.

  14. A postmeningitic cochlear implant patient who was postoperatively diagnosed as having X-linked agammaglobulinemia.

    Science.gov (United States)

    Minoda, Ryosei; Takahashi, Haruo; Miyamaru, Satoru; Masuda, Masako; Miwa, Toru; Sanuki, Tetsuji; Hirai, Toshinori; Yumoto, Eiji

    2012-12-01

    X-linked agammaglobulinemia (XLA) is caused by a mutation in the Bruton tyrosine kinase, leading to an arrest in B cell development. Consequently, patients with XLA show significant decreases in gammaglobulin. Here, we describe a child with postmeningitic deafness and XLA who underwent a cochlear implantation. His psychomotor development had been normal and his congenital immunodeficiency was noticed only postoperatively. Immunoglobulin replacement treatment was started, but he still suffered repeated infections. Eventually, his cochlear implant was removed. A preoperative check of immunological status might be advisable in postmeningitic patients undergoing cochlear implantation to reduce the risk of postoperative infectious complications.

  15. Mutation pattern in the Bruton's tyrosine kinase gene in 26 unrelated patients with X-linked agammaglobulinemia

    DEFF Research Database (Denmark)

    Vorechovský, I; Luo, L; Hertz, Jens Michael

    1997-01-01

    Mutation pattern was characterized in the Bruton's tyrosine kinase gene (BTK) in 26 patients with X-linked agammaglobulinemia, the first described immunoglobulin deficiency, and was related to BTK expression. A total of 24 different mutations were identified. Most BTK mutations were found to resu...

  16. PROTECTIVE LEVELS OF VARICELLA-ZOSTER ANTIBODY DID NOT EFFECTIVELY PREVENT CHICKENPOX IN AN X-LINKED AGAMMAGLOBULINEMIA PATIENT.

    Science.gov (United States)

    Nobre, Fernanda Aimée; Gonzalez, Isabela Garrido da Silva; de Moraes-Pinto, Maria Isabel; Costa-Carvalho, Beatriz Tavares

    2015-01-01

    We describe the case of an eight-year-old boy with X-linked agammaglobulinemia who developed mild varicella despite regular intravenous immunoglobulin (IVIG) therapy. He maintained protective antibody levels against varicella and the previous batches of IVIG that he received had adequate varicella-specific IgG levels. The case illustrates that IVIG may not prevent VZV infection.

  17. Sepsis Caused by Veillonella parvula Infection in a 17-Year-Old Patient with X-Linked Agammaglobulinemia (Bruton's Disease)

    Science.gov (United States)

    Strach, Magdalena; Siedlar, Maciej; Kowalczyk, Danuta; Zembala, Marek; Grodzicki, Tomasz

    2006-01-01

    A case of a male, 17-year-old, X-linked agammaglobulinemia patient with bacteremia caused by Veillonella parvula, without a defined primary site of infection, is presented. The report demonstrates that V. parvula should not be regarded as a nonpathogenic microorganism, at least not in patients with certain forms of immunodeficiency disease. PMID:16825407

  18. Clinical characteristics and genetic profiles of 174 patients with X-linked agammaglobulinemia

    Science.gov (United States)

    Chen, Xia-Fang; Wang, Wei-Fan; Zhang, Yi-Dan; Zhao, Wei; Wu, Jing; Chen, Tong-Xin

    2016-01-01

    Abstract X-linked agammaglobulinemia (XLA) is a humoral primary immunodeficiency. XLA patients typically present with very low numbers of peripheral B cells and a profound deficiency of all immunoglobulin isotypes. Most XLA patients carry mutations in Bruton tyrosine kinase (BTK) gene. The genetic background and clinical features of 174 Chinese patients with XLA were investigated. The relationship between specific BTK gene mutations and severity of clinical manifestations was also examined. Mutations were graded from mild to severe based on structural and functional prediction through bioinformatics analysis. One hundred twenty-seven mutations were identified in 142 patients from 124 families, including 45 novel mutations and 82 recurrent mutations that were distributed over the entire BTK gene sequence. Variation in phenotypes was observed, and there was a tendency of association between genotype and age of disease onset. This report constitutes the largest group of patients with BTK mutations in China. A genotype–phenotype correlation was observed in this study. Early diagnosis of congenital agammaglobulinemia should be based on clinical symptoms, family history, and molecular analysis of the BTK gene. PMID:27512878

  19. Autosomal recessive agammaglobulinemia: novel insights from mutations in Ig-beta.

    Science.gov (United States)

    Lougaris, Vassilios; Ferrari, Simona; Cattalini, Marco; Soresina, Annarosa; Plebani, Alessandro

    2008-09-01

    Agammaglobulinemia is a rare primary immuno-deficiency characterized by an early block of B-cell development in the bone marrow resulting in the absence of peripheral B cells and low/absent immunoglobulin serum levels. Mutations in the Bruton tyrosine kinase and in components of the pre-B-cell receptor (pre-BCR), such as mu heavy chain, surrogate light chain, and Igalpha have been found in 85% to 90% of patients affected by this disease. Here we review the recent advances in the characterization of molecular defects underlying an early block in B-cell development, focusing on the novel finding of the first two patients with agammaglobulinemia caused by mutations in Igbeta, the transmembrane protein that associates with Igalpha as part of the pre-BCR complex. Characterization of novel genetic defects involving components of the pre-BCR is crucial for a better understanding of the biology of early B-cell development and may have therapeutic and prognostic implications.

  20. [A case of chronic enteroviral meningitis and hydrocephalus associated with Bruton type agammaglobulinemia].

    Science.gov (United States)

    Ozawa, T; Onodera, O; Iizuka, O; Tanno, Y; Eguchi, I; Soma, Y; Tsuji, S

    1998-02-01

    We report a 10-year-old boy with chronic enteroviral meningitis associated with agammaglobulinemia (CEMA) and hydrocephalus. He was treated with a low-dose intravenous administration (100 mg/kg/4 weeks) of gammaglobulin (gamma-gl) since he was diagnosed as having Bruton type agammaglobulinemia at 1 year of age. At this admission, neurological examination revealed meningeal signs, Babinski sign, frontal signs, urinary incontinence, and mental retardation (IQ = 48) which was considered to be a sequela of the enteroviral encephalitis which had occurred in his first year of life. T 1-weighted MR imaging of the brain following gadolinium administration revealed a marked dilatation of the lateral ventricles and dense enhancement of the meninges. Enterovirus was detected in the cerebrospinal fluid (CSF) using tissue culture. Histological examination of a biopsied leptomeningeal specimen revealed inflammatory thickening, which was a likely cause of the obstruction to the flow of CSF. The hydrocephalus in this patient was treated with external drainage of CSF from the lateral ventricle. The CEMA was brought into remission by means of the intraventricular administration of gamma-gl, at a dose of 125-250 mg/week (total dose: 1.5 g/8 weeks), in addition to the high dose intravenous administration (400 mg/kg/4 weeks) of gamma-gl. Because of the poor prognosis of patients with CEMA, the intraventricular administration of gamma-gl should be initiated immediately following a diagnosis of enteroviral meningitis.

  1. Bruton's tyrosine kinase: from X-linked agammaglobulinemia toward targeted therapy for B-cell malignancies.

    Science.gov (United States)

    Ponader, Sabine; Burger, Jan A

    2014-06-10

    Discovery of Bruton's tyrosine kinase (BTK) mutations as the cause for X-linked agammaglobulinemia was a milestone in understanding the genetic basis of primary immunodeficiencies. Since then, studies have highlighted the critical role of this enzyme in B-cell development and function, and particularly in B-cell receptor signaling. Because its deletion affects mostly B cells, BTK has become an attractive therapeutic target in autoimmune disorders and B-cell malignancies. Ibrutinib (PCI-32765) is the most advanced BTK inhibitor in clinical testing, with ongoing phase III clinical trials in patients with chronic lymphocytic leukemia and mantle-cell lymphoma. In this article, we discuss key discoveries related to BTK and clinically relevant aspects of BTK inhibitors, and we provide an outlook into clinical development and open questions regarding BTK inhibitor therapy.

  2. Neutropenia associated with X-linked Agammaglobulinemia in an Iranian referral center.

    Science.gov (United States)

    Aghamohammadi, Asghar; Cheraghi, Taher; Rezaei, Nima; Kanegane, Hirokazu; Abdollahzede, Sina; Talaei-Khoei, Mojtaba; Heidari, Golnaz; Zandieh, Fariborz; Moin, Mostafa; Miyawaki, Toshio

    2009-03-01

    X-linked Agammaglobulinemia (XLA) is a hereditary immunodeficiency, characterized by an early onset of recurrent bacterial infections, hypogammaglobulinemia and markedly reduced B lymphocytes number. In order to determine the association of neutropenia among Iranian patients with XLA, hospital records of 30 patients with confirmed XLA in Children Medical Center Hospital, were reviewed. Eight out of 30 XLA patients (26.7%) developed neutropenia during the course of the disease. In two patients, episodes of neutropenia were identified before or at the time of diagnosis of XLA. Other six patients whom were not visited regularly and did not receive periodical immunoglobulin replacement therapy experienced neutropenia after diagnosis of XLA. Neutropenia in XLA is mainly associated with infection and is resolved with intravenous immunoglobulin replacement and antibiotics therapy.

  3. Mutations of Bruton's tyrosine kinase gene in Brazilian patients with X-linked agammaglobulinemia.

    Science.gov (United States)

    Ramalho, V D; Oliveira Júnior, E B; Tani, S M; Roxo Júnior, P; Vilela, M M S

    2010-09-01

    Mutations in Bruton's tyrosine kinase (BTK) gene are responsible for X-linked agammaglobulinemia (XLA), which is characterized by recurrent bacterial infections, profound hypogammaglobulinemia, and decreased numbers of mature B cells in peripheral blood. We evaluated 5 male Brazilian patients, ranging from 3 to 10 years of age, from unrelated families, whose diagnosis was based on recurrent infections, markedly reduced levels of IgM, IgG and IgA, and circulating B cell numbers <2%. BTK gene analysis was carried out using PCR-SSCP followed by sequencing. We detected three novel (Ala347fsX55, I355T, and Thr324fsX24) and two previously reported mutations (Q196X and E441X). Flow cytometry revealed a reduced expression of BTK protein in patients and a mosaic pattern of BTK expression was obtained from mothers, indicating that they were XLA carriers.

  4. Intronic SH2D1A mutation with impaired SAP expression and agammaglobulinemia.

    Science.gov (United States)

    Recher, Mike; Fried, Ari J; Massaad, Michel J; Kim, Hye Young; Rizzini, Michela; Frugoni, Francesco; Walter, Jolan E; Mathew, Divij; Eibel, Hermann; Hess, Christoph; Giliani, Silvia; Umetsu, Dale T; Notarangelo, Luigi D; Geha, Raif S

    2013-02-01

    X-linked lymphoproliferative (XLP) disease is a primary immunodeficiency syndrome associated with the inability to control Epstein-Barr virus (EBV), lymphoma, and hypogammaglobulinemia. XLP is caused by mutations in the SH2D1A gene, which encodes the SLAM-associated protein (SAP), or in the BIRC4 gene, which encodes the X-linked inhibitor of apoptosis protein (XIAP). Here we report a patient with recurrent respiratory tract infections and early onset agammaglobulinemia who carried a unique disease-causing intronic loss-of-function mutation in SH2D1A. The intronic mutation affected SH2D1A gene transcription but not mRNA splicing, and led to markedly reduced level of SAP protein. Despite undetectable serum immunoglobulins, the patient's B cells replicated and differentiated into antibody producing cells normally in vitro.

  5. X-linked agammaglobulinemia associated with B-precursor acute lymphoblastic leukemia.

    Science.gov (United States)

    Hoshino, Akihiro; Okuno, Yusuke; Migita, Masahiro; Ban, Hideki; Yang, Xi; Kiyokawa, Nobutaka; Adachi, Yuichi; Kojima, Seiji; Ohara, Osamu; Kanegane, Hirokazu

    2015-02-01

    X-linked agammaglobulinemia (XLA) is clinically characterized by reduced number of peripheral B cells and diminished levels of serum immunoglobulins, and caused by a mutation in the Bruton's tyrosine kinase (BTK) gene, which play a pivotal role in signal transduction of pre-B-cell receptor (BCR) and BCR. B-cell precursor acute lymphoblastic leukemia (BCP-ALL) is the most common malignancy in children, and it may be associated with gene alterations that regulate B-cell development. Here we described a first case of XLA associated BCP-ALL. The whole-exome sequencing revealed a somatic mutation in MLL2 in the sample from the onset of BCP-ALL. This study suggests that the alterations of BTK and MLL2 synergistically function as leukemogenesis.

  6. X-Linked Agammaglobulinemia Presenting with Secondary Hemophagocytic Syndrome: A Case Report

    Directory of Open Access Journals (Sweden)

    Can Ozturk

    2013-01-01

    Full Text Available Introduction. Coincidence of X-linked agammaglobulinemia (XLA and secondary hemophagocytic syndrome (sHS is atypical. Both diseases are rare and pathogenesis of the latter one is not clearly known. Case Presentation. A 5-year-old boy was diagnosed both with XLA and sHS. However, in his history, he did not have severe and recurrent infections. Bruton tyrosine kinase (BTK gene mutation was present (c.1581_1584delTTTG. To the best of the authors’ knowledge, coincidence of XLA and sHS had not been reported in the literature before. Conclusion. Patients with XLA are extremely vulnerable to recurrent bacterial infections. The diagnosis of XLA with sHS at any time of life is both an interesting and challenging situation without history of recurrent bacterial infections.

  7. X-linked agammaglobulinemia combined with juvenile idiopathic arthritis and invasive Klebsiella pneumoniae polyarticular septic arthritis.

    Science.gov (United States)

    Zhu, Zaihua; Kang, Yuli; Lin, Zhenlang; Huang, Yanjing; Lv, Huoyang; Li, Yasong

    2015-02-01

    X-linked agammaglobulinemia (XLA) is a primary immunodeficiency disease caused by mutations in the Bruton's tyrosine kinase (BTK) gene. XLA can also present in combination with juvenile idiopathic arthritis (JIA), the major chronic rheumatologic disease in children. We report herein the first known case of a juvenile patient diagnosed with XLA combined with JIA that later developed into invasive Klebsiella pneumoniae polyarticular septic polyarthritis. An additional comprehensive review of XLA combined with JIA and invasive K. pneumoniae septic arthritis is also presented. XLA was identified by the detection of BTK mutations while the diagnosis of JIA was established by clinical and laboratory assessments. Septic arthritis caused by invasive K. pneumoniae was confirmed by culturing of the synovia and gene detection of the isolates. Invasive K. pneumoniae infections can not only result in liver abscesses but also septic arthritis, although this is rare. XLA combined with JIA may contribute to invasive K. pneumoniae infection.

  8. Mutations of Bruton's tyrosine kinase gene in Brazilian patients with X-linked agammaglobulinemia

    Directory of Open Access Journals (Sweden)

    V.D. Ramalho

    2010-09-01

    Full Text Available Mutations in Bruton's tyrosine kinase (BTK gene are responsible for X-linked agammaglobulinemia (XLA, which is characterized by recurrent bacterial infections, profound hypogammaglobulinemia, and decreased numbers of mature B cells in peripheral blood. We evaluated 5 male Brazilian patients, ranging from 3 to 10 years of age, from unrelated families, whose diagnosis was based on recurrent infections, markedly reduced levels of IgM, IgG and IgA, and circulating B cell numbers <2%. BTK gene analysis was carried out using PCR-SSCP followed by sequencing. We detected three novel (Ala347fsX55, I355T, and Thr324fsX24 and two previously reported mutations (Q196X and E441X. Flow cytometry revealed a reduced expression of BTK protein in patients and a mosaic pattern of BTK expression was obtained from mothers, indicating that they were XLA carriers.

  9. Clinical and mutational features of X-linked agammaglobulinemia in Mexico.

    Science.gov (United States)

    García-García, E; Staines-Boone, A T; Vargas-Hernández, A; González-Serrano, M E; Carrillo-Tapia, E; Mogica-Martínez, D; Berrón-Ruíz, L; Segura-Mendez, N H; Espinosa-Rosales, F J; Yamazaki-Nakashimada, M A; Santos-Argumedo, L; López-Herrera, G

    2016-04-01

    X-linked agammaglobulinemia (XLA) is caused by BTK mutations, patients typically show <2% of peripheral B cells and reduced levels of all immunoglobulins; they suffer from recurrent infections of bacterial origin; however, viral infections, autoimmune-like diseases, and an increased risk of developing gastric cancer are also reported. In this work, we report the BTK mutations and clinical features of 12 patients diagnosed with XLA. Furthermore, a clinical revision is also presented for an additional cohort of previously reported patients with XLA. Four novel mutations were identified, one of these located in the previously reported mutation refractory SH3 domain. Clinical data support previous reports accounting for frequent respiratory, gastrointestinal tract infections and other symptoms such as the occurrence of reactive arthritis in 19.2% of the patients. An equal proportion of patients developed septic arthritis; missense mutations and mutations in SH1, SH2 and PH domains predominated in patients who developed arthritis.

  10. Agammaglobulinemia in a Patient with Smith-Lemli-Opitz Syndrome: Case Report

    Directory of Open Access Journals (Sweden)

    H. Halik Akar

    2016-02-01

    Full Text Available Smith-Lemli-Opitz syndrome (SLO is a rare autosomal recessive (AR inherited genetic disorder characterized by multiple congenital anomalies, microcephaly, muscular hypotonia, and severe developmental delay. The deficiency of 7-dehydrocholesterol reductase enzyme leads to this syndrome. Patients with SLO display recurrent respiratory infections due to secondary muscular hypotonia which leads to decreased motility and respiratory effort. In this study, we report a 1-year-old boy with SLO presented with recurrent urinary infections and chronic diarrhea with Klebsiella pneumonia positivity in the rectal swabs. The patient had also markedly decreased immunoglobulin G (IgG between 50-100 g/dl. In follow-up of patient, markedly clinical improvement was observed with intravenous immunoglobulin (IVIG replacement. With this study, we would like to draw attention; recurrent infections may indicate primary immunodeficiencies such as agammaglobulinemia in patients with SLO.

  11. [Intrathecal interferon therapy in chronic echovirus meningoencephalitis in Bruton type agammaglobulinemia].

    Science.gov (United States)

    von der Wense, A; Herrmann, B; Deppermann, R; Harms, F; Wehinger, H

    1998-01-01

    A 9-year-old body with X-linked agammaglobulinemia developed chronic enteroviral meningoencephalitis (CEMA) caused by echovirus type 6. Intravenous treatment with selected immunoglobulin charges containing high titers against echovirus type 6 or combination with beta-interferon did not result in improvement. After implantation of a Rickham reservoir and periodical administration of intraventricular and intravenous immunoglobulin the virus recurred rapidly each time treatment was stopped. After 20 months of treatment the patient received a combined therapy with beta-interferon and selected immunoglobulin. Both drugs were given by lumbar puncture, intravenously and via Rickham reservoir. Subsequently echovirus type 6 could not be isolated in culture or PCR. Cerebrospinal fluid pleocytosis disappeared. The remission is lasting for more than three years. Intrathecal and intraventricular beta-interferon therapy for CEMA is being reported for the first time. Facing the unfavourable prognosis of the disease this mode of treatment is a new therapeutic approach following failure of other therapies.

  12. PROTECTIVE LEVELS OF VARICELLA-ZOSTER ANTIBODY DID NOT EFFECTIVELY PREVENT CHICKENPOX IN AN X-LINKED AGAMMAGLOBULINEMIA PATIENT

    Directory of Open Access Journals (Sweden)

    Fernanda Aimée NOBRE

    2015-10-01

    Full Text Available SUMMARY We describe the case of an eight-year-old boy with X-linked agammaglobulinemia who developed mild varicella despite regular intravenous immunoglobulin (IVIG therapy. He maintained protective antibody levels against varicella and the previous batches of IVIG that he received had adequate varicella-specific IgG levels. The case illustrates that IVIG may not prevent VZV infection.

  13. Splice-correcting oligonucleotides restore BTK function in X-linked agammaglobulinemia model.

    Science.gov (United States)

    Bestas, Burcu; Moreno, Pedro M D; Blomberg, K Emelie M; Mohammad, Dara K; Saleh, Amer F; Sutlu, Tolga; Nordin, Joel Z; Guterstam, Peter; Gustafsson, Manuela O; Kharazi, Shabnam; Piątosa, Barbara; Roberts, Thomas C; Behlke, Mark A; Wood, Matthew J A; Gait, Michael J; Lundin, Karin E; El Andaloussi, Samir; Månsson, Robert; Berglöf, Anna; Wengel, Jesper; Smith, C I Edvard

    2014-09-01

    X-linked agammaglobulinemia (XLA) is an inherited immunodeficiency that results from mutations within the gene encoding Bruton's tyrosine kinase (BTK). Many XLA-associated mutations affect splicing of BTK pre-mRNA and severely impair B cell development. Here, we assessed the potential of antisense, splice-correcting oligonucleotides (SCOs) targeting mutated BTK transcripts for treating XLA. Both the SCO structural design and chemical properties were optimized using 2'-O-methyl, locked nucleic acid, or phosphorodiamidate morpholino backbones. In order to have access to an animal model of XLA, we engineered a transgenic mouse that harbors a BAC with an authentic, mutated, splice-defective human BTK gene. BTK transgenic mice were bred onto a Btk knockout background to avoid interference of the orthologous mouse protein. Using this model, we determined that BTK-specific SCOs are able to correct aberrantly spliced BTK in B lymphocytes, including pro-B cells. Correction of BTK mRNA restored expression of functional protein, as shown both by enhanced lymphocyte survival and reestablished BTK activation upon B cell receptor stimulation. Furthermore, SCO treatment corrected splicing and restored BTK expression in primary cells from patients with XLA. Together, our data demonstrate that SCOs can restore BTK function and that BTK-targeting SCOs have potential as personalized medicine in patients with XLA.

  14. High-throughput sequencing reveals an altered T cell repertoire in X-linked agammaglobulinemia.

    Science.gov (United States)

    Ramesh, Manish; Simchoni, Noa; Hamm, David; Cunningham-Rundles, Charlotte

    2015-12-01

    To examine the T cell receptor structure in the absence of B cells, the TCR β CDR3 was sequenced from DNA of 15 X-linked agammaglobulinemia (XLA) subjects and 18 male controls, using the Illumina HiSeq platform and the ImmunoSEQ analyzer. V gene usage and the V-J combinations, derived from both productive and non-productive sequences, were significantly different between XLA samples and controls. Although the CDR3 length was similar for XLA and control samples, the CDR3 region of the XLA T cell receptor contained significantly fewer deletions and insertions in V, D, and J gene segments, differences intrinsic to the V(D)J recombination process and not due to peripheral T cell selection. XLA CDR3s demonstrated fewer charged amino acid residues, more sharing of CDR3 sequences, and almost completely lacked a population of highly modified Vβ gene segments found in control DNA, suggesting both a skewed and contracted T cell repertoire in XLA.

  15. Relapsing Campylobacter jejuni Systemic Infections in a Child with X-Linked Agammaglobulinemia

    Directory of Open Access Journals (Sweden)

    Paola Ariganello

    2013-01-01

    Full Text Available X-linked agammaglobulinemia (XLA is a primary immunodeficiency of the humoral compartment, due to a mutation in the Bruton tyrosine kinase (BTK gene, characterized by a severe defect of circulating B cells and serum immunoglobulins. Recurrent infections are the main clinical manifestations; although they are especially due to encapsulated bacteria, a specific association with Campylobacter species has been reported. Here, we report the case of a boy with XLA who presented with relapsing Campylobacter jejuni systemic infections. His clinical history supports the hypothesis of the persistence of C. jejuni in his intestinal tract. Indeed, as previously reported, XLA patients may become chronic intestinal carriers of Campylobacter, even in absence of symptoms, with an increased risk of relapsing bacteraemia. The humoral defect is considered to be crucial for this phenomenon, as well as the difficulties to eradicate the pathogen with an appropriate antibiotic therapy; drug resistance is raising in Campylobacter species, and the appropriate duration of treatment has not been established. C. jejuni should always be suspected in XLA patients with signs and symptoms of systemic infection, and treatment should be based on antibiogram to assure the eradication of the pathogen.

  16. Splice-correction strategies for treatment of X-linked agammaglobulinemia.

    Science.gov (United States)

    Bestas, Burcu; Turunen, Janne J; Blomberg, K Emelie M; Wang, Qing; Månsson, Robert; El Andaloussi, Samir; Berglöf, Anna; Smith, C I Edvard

    2015-03-01

    X-linked agammaglobulinemia (XLA) is a primary immunodeficiency disease caused by mutations in the gene coding for Bruton's tyrosine kinase (BTK). Deficiency of BTK leads to a developmental block in B cell differentiation; hence, the patients essentially lack antibody-producing plasma cells and are susceptible to various infections. A substantial portion of the mutations in BTK results in splicing defects, consequently preventing the formation of protein-coding mRNA. Antisense oligonucleotides (ASOs) are therapeutic compounds that have the ability to modulate pre-mRNA splicing and alter gene expression. The potential of ASOs has been exploited for a few severe diseases, both in pre-clinical and clinical studies. Recently, advances have also been made in using ASOs as a personalized therapy for XLA. Splice-correction of BTK has been shown to be feasible for different mutations in vitro, and a recent proof-of-concept study demonstrated the feasibility of correcting splicing and restoring BTK both ex vivo and in vivo in a humanized bacterial artificial chromosome (BAC)-transgenic mouse model. This review summarizes the advances in splice correction, as a personalized medicine for XLA, and outlines the promises and challenges of using this technology as a curative long-term treatment option.

  17. Females with a disorder phenotypically identical to X-linked agammaglobulinemia

    Energy Technology Data Exchange (ETDEWEB)

    Conley, M.E. (Univ. of Tennessee College of Medicine, Memphis (United States)); Sweinberg, S.K. (Children' s Hospital of Philadelphia, PA (United States))

    1992-03-01

    Clinical and laboratory findings in two girls with a disorder phenotypically indistinguishable from typical X-linked agammaglobulinemia (XLA) are described. To examine the possibility that subtle defects in the X chromosome might explain the findings, detailed genetic studies were performed on one of these patients. Cytogenetic studies showed a normal 46XX karyotype. Southern blot analysis of her DNA showed that she had inherited a maternal and a paternal allele at sites flanking the locus for typical XLA at Xq22, making a microdeletion or uniparental disomy unlikely. To determine whether both of her X chromosomes could function as the active X, somatic-cell hybrids that selectively retained the active X were produced from her activated T cells. A normal random pattern of X inactivation was seen. Of 21 T-cell hybrids, 3 retained both X chromosomes, 7 had one X as the active X, and 11 had the other X as the active X. The authors have interpreted these studies as indicating that there is an autosomal recessive disorder that is phenotypically identical to XLA.

  18. The genomic structure of human BTK, the defective gene in X-linked agammaglobulinemia

    Energy Technology Data Exchange (ETDEWEB)

    Rohrer, J.; Parolini, O. [St. Jude Children`s Research Hospital, Memphis, TN (United States); Conley, M.E. [St. Jude Children`s Research Hospital, Memphis, TN (United States)]|[Univ. of Tennessee College of Medicine, Memphis, TN (United States); Belmont, J.W. [Baylor College of Medicine, Houston, TX (United States)

    1994-12-31

    It has recently been demonstrated that mutations in the gene for Bruton`s tyrosine kinase (BTK) are responsible for X-linked agammaglobulinemia. Southern blot analysis and sequencing of cDNA were used to document deletions, insertions, and single base pair substitutions. To facilitate analysis of BTK regulation and to permit the development of assays that could be used to screen genomic DNA for mutations in BTK, the authors determined the genomic organization of this gene. Subcloning of a cosmid and a yeast artificial chromosome showed that BTK is divided into 19 exons spanning 37 kilobases of genomic DNA. Analysis of the region 5{prime} to the first untranslated exon revealed no consensus TATAA or CAAT boxes; however, three retinoic acid binding sites were identified in this region. Comparison of the structure of BTK with that of other nonreceptor tyrosine kinases, including SRC, FES, and CSK, demonstrated a lack of conservation of exon borders. Information obtained in this study will contribute to understanding of the evolution of nonreceptor tyrosine kinases. It will also be useful in diagnostic studies, including carrier detection, and in studies directed towards gene therapy or gene replacement. 29 refs., 2 figs., 2 tabs.

  19. Recurrent pneumonia with mild hypogammaglobulinemia diagnosed as X-linked agammaglobulinemia in adults

    Directory of Open Access Journals (Sweden)

    Tsuchiya Shigeru

    2001-04-01

    Full Text Available Abstract Background X-linked agammaglobulinemia (XLA is a humoral immunodeficiency caused by disruption of the Bruton's tyrosine kinase (BTK gene. Typical XLA patients suffer recurrent and severe bacterial infections in childhood. Methods Flow cytometric analysis of the peripheral monocytes using the anti-BTK antibody was used to characterize a 27 year old male patient with mild hypogammaglobulinemia (IgG, 635 mg/dl; IgM, 11 mg/dl; IgA, Results Flow cytometric analysis of cytoplasmic BTK protein in peripheral monocytes indicated that the patient presents a rare case of adult-onset XLA and that his mother is an XLA carrier. Sequencing of the BTK gene revealed a deletion of AG in the codon for Glu605 (AGT, resulting in an aberrant stop codon that truncates the BTK protein in its kinase domain. Conclusions This case suggests that some XLA cases may remain undiagnosed because they only show mild hypogammaglobulinemia and they lack repeated infections in childhood. Flow cytometric analysis is a powerful method to screen these patients.

  20. Splice-correcting oligonucleotides restore BTK function in X-linked agammaglobulinemia model

    Science.gov (United States)

    Bestas, Burcu; Moreno, Pedro M.D.; Blomberg, K. Emelie M.; Mohammad, Dara K.; Saleh, Amer F.; Sutlu, Tolga; Nordin, Joel Z.; Guterstam, Peter; Gustafsson, Manuela O.; Kharazi, Shabnam; Piątosa, Barbara; Roberts, Thomas C.; Behlke, Mark A.; Wood, Matthew J.A.; Gait, Michael J.; Lundin, Karin E.; El Andaloussi, Samir; Månsson, Robert; Berglöf, Anna; Wengel, Jesper; Smith, C.I. Edvard

    2014-01-01

    X-linked agammaglobulinemia (XLA) is an inherited immunodeficiency that results from mutations within the gene encoding Bruton’s tyrosine kinase (BTK). Many XLA-associated mutations affect splicing of BTK pre-mRNA and severely impair B cell development. Here, we assessed the potential of antisense, splice-correcting oligonucleotides (SCOs) targeting mutated BTK transcripts for treating XLA. Both the SCO structural design and chemical properties were optimized using 2′-O-methyl, locked nucleic acid, or phosphorodiamidate morpholino backbones. In order to have access to an animal model of XLA, we engineered a transgenic mouse that harbors a BAC with an authentic, mutated, splice-defective human BTK gene. BTK transgenic mice were bred onto a Btk knockout background to avoid interference of the orthologous mouse protein. Using this model, we determined that BTK-specific SCOs are able to correct aberrantly spliced BTK in B lymphocytes, including pro–B cells. Correction of BTK mRNA restored expression of functional protein, as shown both by enhanced lymphocyte survival and reestablished BTK activation upon B cell receptor stimulation. Furthermore, SCO treatment corrected splicing and restored BTK expression in primary cells from patients with XLA. Together, our data demonstrate that SCOs can restore BTK function and that BTK-targeting SCOs have potential as personalized medicine in patients with XLA. PMID:25105368

  1. Gastric adenocarcinoma in a patient with X-linked agammaglobulinemia and HIV: Case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Joud Hajjar

    2016-09-01

    Full Text Available X-linked agammaglobulinemia (XLA is an X-linked inherited disease usually caused by a germline mutation in the BTK gene leading to Bruton’s tyrosine kinase deficiency, which results in the impaired development of B-lymphocytes and a subsequent lack of immunoglobulin production. Patients with XLA have an increased susceptibility to bacterial and viral infections, and multiple case reports have been published regarding an association between XLA and gastrointestinal (GI malignancy. Here, we describe a case of a 25-year-old man with XLA and HIV, who developed gastric adenocarcinoma. Previously reported cases of XLA and GI malignancy are also reviewed and summarized.

  2. Recurrent pyogenic meningitis in a 17-year-old: A delayed presentation of X-linked agammaglobulinemia with growth hormone deficiency

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    Girish R Sabnis

    2011-01-01

    Full Text Available We report an adolescent male with X-linked agammaglobulinemia (XLA and recurrent episodes of pyogenic meningitis. The workup for proportionate short stature revealed isolated growth hormone deficiency. This patient highlights the delayed presentation of the XLA variant and the need to consider primary immunodeficiency in patients with recurrent serious infections, irrespective of age.

  3. Bruton's tyrosine kinase gene mutations in Turkish patients with X-linked agammaglobulinemia from a single center: Novel mutations in βTK gene

    NARCIS (Netherlands)

    Ç. Aydoǧmuş (Çiǧdem); Y. Camcioǧlu (Yildiz); M. van der Burg (Mirjam); H. Çokuǧraş (H.); N. Akçakaya (Necla); J.J.M. van Dongen (Jacques)

    2013-01-01

    textabstractObjective: X-linked agammaglobulinemia (XLA) is caused by a mutation in the Bruton's tyrosine kinase gene and is characterized by a delay in the maturation and differentiation of B lymphocytes. Patients with XLA have either absent or very low levels of circulating mature B cells (<1%), p

  4. Composition of precursor B-cell compartment in bone marrow from patients with X-linked agammaglobulinemia compared with healthy children

    NARCIS (Netherlands)

    J.G. Noordzij; S. de Bruin-Versteeg (Sandra); W.M. Comans-Bitter; N.G. Hartwig (Nico); R.W. Hendriks (Rudi); R. de Groot (Ronald); J.J.M. van Dongen (Jacques)

    2002-01-01

    textabstractX-linked agammaglobulinemia (XLA) is characterized by a severe B-cell deficiency, resulting from a differentiation arrest in the bone marrow (BM). Because XLA is clinically and immunologically heterogeneous, we investigated whether the B-cell differentiation arrest in B

  5. Mutational analysis of Btk, the defective gene in X-linked agammaglobulinemia

    Energy Technology Data Exchange (ETDEWEB)

    Conley, M.E.; Fitch-Hilgenberg, M.E.; Rohrer, J. [St. Jude Children`s Research Hospital, Memphis, TN (United States)

    1994-09-01

    Recent studies have shown that X-linked agammaglobulinemia (XLA), a disorder of B cell development, is due to mutations in an scr-like cytoplasmic tyrosine kinase, Btk. Thus far, mutations in this gene have been identified by sequencing of cDNA. To permit the detection of mutations in genomic DNA, we determined the structure of Btk and identified 19 exons in 37 kb of DNA. PCR primers were designed to amplify each exon with its splice sites. Two overlapping PCR products were employed for exons longer than 230 base pairs. Single strand conformation polymorphism (SSCP) analysis was used to screen genomic DNA from 30 unrelated families presumed to carry a mutation in Btk. It was possible to amplify DNA in every reaction from every patient. None of the DNA samples demonstrated more than one aberrant SSCP pattern. Twenty three mutations were detected in 25 families. Seven point mutations resulting in amino acid substitutions were seen. An additional 7 base pair substitutions gave rise to premature stop codons. Two splice defects were noted. Small insertions or deletions, all resulting in frameshifts and premature stop codons were seen in eight patients. One patient had an A to G transition in the ATG start codon. Two mutations, both at CpG dinucleotides, were seen in more than one family. Haplotype analysis, using CA repeats closely linked to Btk, demonstrated that the mutations in these families arose independently. We conclude from these studies that the mutations in Btk in patients with XLA are highly variable. Large deletions are uncommon, although small 1 to 4 bp insertions or deletions constitute as many as one third of the mutations. Further analysis of patients with amino acid substitutions will permit structure/function correlations.

  6. X-linked agammaglobulinemia diagnosed late in life: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Krishnaswamy Guha

    2008-06-01

    Full Text Available Abstract Background Common variable immune deficiency (CVID, one of the most common primary immunodeficiency diseases presents in adults, whereas X-linked agammaglobulinemia (XLA, an inherited humoral immunodeficiency, is usually diagnosed early in life after maternal Igs have waned. However, there have been several reports in the world literature in which individuals have either had a delay in onset of symptoms or have been misdiagnosed with CVID and then later found to have mutations in Bruton's tyrosine kinase (BTK yielding a reclassification as adult-onset variants of XLA. The typical finding of absent B cells should suggest XLA rather than CVID and may be a sensitive test to detect this condition, leading to the more specific test (Btk mutational analysis. Further confirmation may be by mutational analyses. Methods The records of 2 patients were reviewed and appropriate clinical data collected. BTK mutational analysis was carried out to investigate the suspicion of adult-presentation of XLA. A review of the world literature on delayed diagnosis of XLA and mild or "leaky" phenotype was performed. Results 2 patients previously diagnosed with CVID associated with virtual absence of CD19+ B cells were reclassified as having a delayed diagnosis and adult-presentation of XLA. Patient 1, a 64 yr old male with recurrent sinobronchial infections had a low level of serum IgG of 360 mg/dl (normal 736–1900, IgA Patient 2, a 46 yr old male with recurrent sinopulmonary infections had low IgG of 260 mg/dl, low IgA Conclusion These two cases represent an unusual adult-presentation of XLA, a humoral immunodeficiency usually diagnosed in childhood and the need to further investigate a suspicion of XLA in adult males with CVID particularly those associated with low to absent CD19+ B cells. A diagnosis of XLA can have significant implications including family counseling, detecting female carriers, and early intervention and treatment of affected male

  7. Consequences of two naturally occurring missense mutations in the structure and function of Bruton agammaglobulinemia tyrosine kinase.

    Science.gov (United States)

    Vargas-Hernández, Alexander; López-Herrera, Gabriela; Maravillas-Montero, José L; Vences-Catalán, Felipe; Mogica-Martínez, Dolores; Rojo-Domínguez, Arturo; Espinosa-Rosales, Francisco J; Santos-Argumedo, Leopoldo

    2012-04-01

    Bruton agammaglobulinemia tyrosine kinase (BTK) is a key protein in the B-cell receptor (BCR) signaling pathway and plays an essential role in the differentiation of B lymphocytes. X-linked agammaglobulinemia (XLA) is a primary humoral immunodeficiency caused by mutations in the gene encoding BTK. Previously, we identified two novel variations, L111P and E605G, in BTK; these are localized within the pleckstrin homology and Src homology 1 domains, respectively. In the present study, we evaluated the potential effects of these variations on the structural conformation and the function of BTK. Using in silico methods, we found that the L111P and E650G variations are not located directly in protein-protein interfaces but close to them. They distorted the native structural conformation of the BTK protein, affecting not only its geometry and stability but also its ability for protein recognition and in consequence its functionality. To confirm the results of the in silico assays, WT BTK, L111P, and E650G variants were expressed in the BTK-deficient DT40 cell line. The mutant proteins exhibited an absence of catalytic activity, aberrant redistribution after BCR-crosslinking, and deficient intracellular calcium mobilization. This work demonstrates that L111 and E605 residues are fundamental for the activation and function of BTK.

  8. Clinical characteristics and genetic profiles of 174 patients with X-linked agammaglobulinemia: Report from Shanghai, China (2000-2015).

    Science.gov (United States)

    Chen, Xia-Fang; Wang, Wei-Fan; Zhang, Yi-Dan; Zhao, Wei; Wu, Jing; Chen, Tong-Xin

    2016-08-01

    X-linked agammaglobulinemia (XLA) is a humoral primary immunodeficiency. XLA patients typically present with very low numbers of peripheral B cells and a profound deficiency of all immunoglobulin isotypes. Most XLA patients carry mutations in Bruton tyrosine kinase (BTK) gene.The genetic background and clinical features of 174 Chinese patients with XLA were investigated. The relationship between specific BTK gene mutations and severity of clinical manifestations was also examined. Mutations were graded from mild to severe based on structural and functional prediction through bioinformatics analysis.One hundred twenty-seven mutations were identified in 142 patients from 124 families, including 45 novel mutations and 82 recurrent mutations that were distributed over the entire BTK gene sequence. Variation in phenotypes was observed, and there was a tendency of association between genotype and age of disease onset.This report constitutes the largest group of patients with BTK mutations in China. A genotype-phenotype correlation was observed in this study. Early diagnosis of congenital agammaglobulinemia should be based on clinical symptoms, family history, and molecular analysis of the BTK gene.

  9. Linkage analysis and physical mapping near the gene for x-linked agammaglobulinemia at Xq22

    Energy Technology Data Exchange (ETDEWEB)

    Parolini, O.; Lassiter, G.L.; Henry, M.J.; Conley, M.E. (Univ. of Tennessee College of Medicine, Memphis (United States) St. Jude Children' s Research Hospital, Memphis, TN (United States)); Hejtmancik, J.F. (National Inst. of Health, Bethesda, MD (United States)); Allen, R.C.; Belmont, J.W. (Baylor College of Medicine, Houston, TX (United States)); Barker, D.F. (Univ. of Utah, Salt Lake City (United States))

    1993-02-01

    The gene for x-linked agammaglobulinemia (XLA) has been mapped to Xq22. No recombinations have been reported between the gene and the prob p212 at DXS178; however, this probe is informative in only 30-40% of women and the reported flanking markers, DXS3 and DXS94, and 10-15 cM apart. To identify additional probes that might be useful in genetic counseling, we examined 11 polymorphisms that have been mapped to the Xq21.3-q22 region in 13 families with XLA. In addition, pulsed-field gel electrophoresis and yeast artificial chromosomes (YACs) were used to further characterize the segman of DNA within which the gene for SLA must lie. The results demonstrated that DXS366 and DXS442, which share a 430-kb pulsed-field fragment, could replace DXS3 as proximal flanking markers. Probes at DXS178 and DXS265 identified the same 145-kb pulsed-field fragment, and both loci were contained within a 200-kb YAC identified with the probe p212. A highly polymorphic CA repeat (DCS178CA) was isolated from one end of this YAC and used in linkage analysis. Probes at DXS101 and DXS328 shared several pulsed-field fragments, the smallest of which was 250 kb. No recombinations were seen between XLA and the DXS178-DXS265-DXS178CA complex, DXS101, DXS328, DXS87, or the gene for proteolipid protein (PLP). Key crossovers, when combined with the linkage data from families with Alport syndrome, suggested the following order of loci: cen-DXS3-DXS366-DXS442-(PLP, DXS101, DXS328, DXS178-DXS265-DXS178CA complex, XL)-(DXS87, DXS94)-DXS327-(DXS350, DXS362)-tel. Our studies also limit the segment of DNA within which the XLA gene must lie to the 3- to 4-cM distance between DCS442 and DXS94 and they identify and orient polymorphisms that can be used in genetic counseling not only for XLA but also for Pelizaeus-Merzbacher disease (PLP deficiency), Alport syndrome (COL4A5 deficiency), and Fabry disease ([alpha]-galactosidase A difficiency). 31 refs., 5 figs., 2 tabs.

  10. Gastric adenocarcinoma in the context of X-linked agammaglobulinemia: case report and review of the literature.

    Science.gov (United States)

    Staines Boone, Aidé Tamara; Torres Martínez, María Guadalupe; López Herrera, Gabriela; de Leija Portilla, Julia O; Espinosa Padilla, Sara Elva; Espinosa Rosales, Francisco J; Lugo Reyes, Saúl Oswaldo

    2014-02-01

    The hallmarks of X-linked Agammaglobulinemia (XLA) are panhypogammaglobulinemia, absent B-cells, and recurrent sinopulmonary and gastrointestinal infections starting at an early age, as well as other infections like cellulitis, meningitis, arthritis and sepsis. A number of non-infectious complications have been reported in these patients, including autoimmune diseases and malignancy, especially lymphomas. Here, we report the case of a 30-year old man who developed gastric adenocarcinoma in the context of XLA. Previous reports of, and hypotheses addressing the development of cancer in patients with XLA, are also summarized. Solid cancer in XLA affects mainly the gastrointestinal tract and seems to be related to chronic infection. A natural evolution can be traced back from gastric adenocarcinoma to megaloblastic anemia due to achlorhydria in the context of chronic infection; periodic endoscopy thus seems justified to detect and treat carcinoma in early stages.

  11. A novel BTK gene mutation creates a de-novo splice site in an X-linked agammaglobulinemia patient.

    Science.gov (United States)

    Chear, Chai Teng; Ripen, Adiratna Mat; Mohamed, Sharifah Adlena Syed; Dhaliwal, Jasbir Singh

    2015-04-15

    Bruton's tyrosine kinase (BTK), encoded by the BTK gene, is a cytoplasmic protein critical in B cell development. Mutations in the BTK gene cause X-linked agammaglobulinemia (XLA), a primary immunodeficiency with characteristically low or absent B cells and antibodies. This report describes a five year-old boy who presented with otitis externa, arthritis, reduced immunoglobulins and no B cells. Flow cytometry showed undetectable monocyte BTK expression. Sequencing revealed a novel mutation at exon 13 of the BTK gene which created a de novo splice site with a proximal 5 nucleotide loss resulting in a truncated BTK protein. The patient still suffered from ear infection despite intravenous immunoglobulin replacement therapy. In this study, mosaicism was seen only in the mother's genomic DNA. These results suggest that a combination of flow cytometry and BTK gene analysis is important for XLA diagnosis and carrier screening.

  12. Maxillary distraction osteogenesis for treatment of cleft lip and palate in a patient with X-linked agammaglobulinemia.

    Science.gov (United States)

    Sato, Yutaka; Mishimagi, Takashi; Katsuki, Yuko; Harada, Kiyoshi

    2014-07-01

    X-linked agammaglobulinemia (XLA) is a congenital immune deficiency disorder caused by abnormal antibody production. It is a rare disease with an estimated frequency of 1 in 379,000 that has X-linked recessive heredity and develops only in males. The clinical problems include bacterial infection such as otitis media, sinusitis, and bronchitis. In recent years it has become possible to diagnose XLA in the early stage and intravenous immunoglobulin replacement therapy has permitted survival to adulthood. However, there have been no reports of oral surgery in patients with XLA. Here, we describe a case in which immunoglobulin replacement therapy given pre- and postoperatively was used to control infection in oral surgery and maxillary distraction osteogenesis performed for improving occlusion and appearance of a cleft lip and palate in a patient with XLA.

  13. A novel Bruton's tyrosine kinase gene (BTK) invariant splice site mutation in a Malaysian family with X-linked agammaglobulinemia.

    Science.gov (United States)

    Chear, Chai Teng; Gill, Harvindar Kaur; Ramly, Nazatul Haslina; Dhaliwal, Jasbir Singh; Bujang, Noraini; Ripen, Adiratna Mat; Mohamad, Saharuddin Bin

    2013-12-01

    X-linked agammaglobulinemia (XLA) is a rare genetic disorder caused by mutations in the Bruton's tyrosine kinase (BTK) gene. These mutations cause defects in early B cell development. A patient with no circulating B cells and low serum immunoglobulin isotypes was studied as were his mother and sister. Monocyte BTK protein expression was evaluated by flow cytometry. The mutation was determined using PCR and followed by sequencing. Flow cytometry showed the patient lacked BTK protein expression in his monocytes while the mother and sister had 62% and 40% of the monocytes showing BTK protein expressions respectively. The patient had a novel base substitution in the first nucleotide of intron 9 in the BTK gene, and the mutation was IVS9+1Gagammaglobulinemia and may be used for subsequent genetic counseling, carrier detection and prenatal diagnosis.

  14. X-linked agammaglobulinemia in community-acquired pneumonia cases revealed by immunoglobulin level screening at hospital admission.

    Science.gov (United States)

    Vancikova, Z; Freiberger, T; Vach, W; Trojanek, M; Rizzi, M; Janda, A

    2013-11-01

    In children with primary immunodeficiencies, the onset of symptoms precedes the diagnosis and the initiation of appropriate treatment by months or years. This delay in diagnosis is due to the fact that while these disorders are rare, some of the infections seen in immunodeficient patients are common. Defective antibody production represents the largest group among these disorders, with otitis, sinusitis and pneumonia as the most frequent initial manifestation. We performed a prospective study of humoral immunity in children hospitalized due to community-acquired pneumonia in tertiary care hospital. Out of 254 patients (131 boys, 123 girls, median age 4.5 years) recruited over 3 years, we found 2 boys (age 11 and 21 months) lacking serum immunoglobulins and circulating B cells. Subsequent genetic analysis confirmed diagnosis of X-linked agammaglobulinemia. Despite their immunodeficiency, the pneumonia was uncomplicated in both patients and did not call for immunological evaluation. However, the immunoglobulin screening at admission allowed for an early diagnosis of the immunodeficiency and timely initiation of immunoglobulin substitution, the key prerequisite for a favorable course of the disease.Simple and inexpensive immuno-globulin measurement during the manage-ment of hospitalized children with community-acquired pneumonia may help in early identification of patients with compromised humoral immunity and prevent serious complications.

  15. "Screening of the Bruton Tyrosine Kinase (BTK Gene Mutations in 13 Iranian Patients with Presumed X-Linked Agammaglobulinemia "

    Directory of Open Access Journals (Sweden)

    "Asghar Aghamohammadi

    2004-12-01

    Full Text Available X-linked agammaglobulinemia (XLA is an immunodeficiency caused by mutations in the Bruton tyrosine kinase (Btk gene. In order to identify the mutations in Btk gene in Iranian patients with antibody deficiency, 13 male patients with an XLA phenotype from 11 unrelated families were enrolled as the subjects of investigation for Btk mutation analysis using PCR-SSCP followed by sequencing. Five different mutations were identified in 5 patients from 5 unrelated families. Three mutations had been reported previously including TTTG deletion in intron 15 (4 bps upstream of exon 16 boundary, nonsense point mutation (1896G>A that resulted in a premature stop codon (W588X in kinase domain, and nucleotide alteration in invariant splice donor site of exon12 (IVS12+1G>A. While 2 novel missense mutations (2084A>G, 1783T>C were identified leading to amino acid changes (I651T, Y551H. The results of this study further support the notion that molecular genetic testing represents an important tool for definitive and early diagnosis of XLA and may allow accurate carrier detection and prenatal diagnosis.

  16. 605 X-linked Agammaglobulinemia: Report of 4 Cases of Mexican Patients at Civil Hospital of Guadalajara Dr Juan I. Menchaca

    Science.gov (United States)

    Nuñez-Nuñez, Maria Enriqueta; Padilla-Jimenez, Alondra; Cortes-Grimaldo, Rosa Maria; Ortega-Cisneros, Margarita; Moran-Mendoza, Rocio; Torres-Lozano, Carlos

    2012-01-01

    Background The X-linked agammaglobulinemia is a primary immunodeficiency featured by hypogammaglobulinemia, recurrent infections and low levels of circulating B Lymphocytes, caused by a mutation of the tyrosine kinase of Bruton (Btk). The aim of this work is to present clinical and laboratory evidence of 4 patients with high suspect to bear a Bruton's agammaglobulinemia. Methods We review medical records of 4 patients bearing a humoral immunodeficiency probably Bruton's agammaglobulinemia. Results Patient 1: 20 years old with IgG of 197 mg/dL, IgM 14.6 mg/dL, IgA 10 mg/dL, IgE 0 UI/mL and B cells 0.02%. He has a brother with hypogammaglobulinemia, 2 maternal uncles died with history of recurrent infections. Patient 2: 13 years old, with IgG 33.3 mg/dL, IgM 6.07 mg/dL, IgA 6.07 mg/dL, IgE 0.5 UI/mL and B cells 0.03%. Six maternal uncles and 2 aunts have died at early age. Patient 3: 6 years old, IgG, IgM, IgA and IgE not detectable and B cells 0.4%. One brother died as newborn. Patient 4: 6 years old, with IgG 33 mg/dL, IgM 98.7 mg/dL, IgA 6.67 mg/dL and B cells 2%. The IgM maintained elevated until the age of 4 years old, afterwards was undetectable. He had 2 maternal uncles that had died at early age. All of our patients have presented infections before 6 months of age such as otitis, pansinusitis, septic arthritis, mastoiditis, pneumonia. Two of them with pleural efusion and patient 4 with bronchiectasis and atelectasis. Conclusions Because of the clinical findings of our 4 patients, immunoglobulin levels, the low percentage of B cells, the early death of family members and all of them arer males, we consider that the molecular defect in our patients could be at Btk gene and the diagnosis most probable would be Bruton's agammaglobulinemia.

  17. Genetic and demographic features of X-linked agammaglobulinemia in Eastern and Central Europe: a cohort study.

    Science.gov (United States)

    Tóth, Beáta; Volokha, Alla; Mihas, Alexander; Pac, Malgorzata; Bernatowska, Ewa; Kondratenko, Irina; Polyakov, Alexander; Erdos, Melinda; Pasic, Srdjan; Bataneant, Michaela; Szaflarska, Anna; Mironska, Kristina; Richter, Darko; Stavrik, Katarina; Avcin, Tadej; Márton, Gabriella; Nagy, Kálmán; Dérfalvi, Beáta; Szolnoky, Miklós; Kalmár, Agnes; Belevtsev, Michael; Guseva, Marina; Rugina, Aurica; Kriván, Gergely; Timár, László; Nyul, Zoltán; Mosdósi, Bernadett; Kareva, Lidija; Peova, Sonja; Chernyshova, Liudmyla; Gherghina, Ioan; Serban, Margit; Conley, Mary Ellen; Notarangelo, Luigi D; Smith, C I Edvard; van Dongen, Jacques; van der Burg, Mirjam; Maródi, László

    2009-06-01

    Primary immunodeficiency disorders are a recognized public health problem worldwide. The prototype of these conditions is X-linked agammaglobulinemia (XLA) or Bruton's disease. XLA is caused by mutations in Bruton's tyrosine kinase gene (BTK), preventing B cell development and resulting in the almost total absence of serum immunoglobulins. The genetic profile and prevalence of XLA have not previously been studied in Eastern and Central European (ECE) countries. We studied the genetic and demographic features of XLA in Belarus, Croatia Hungary, Poland, Republic of Macedonia, Romania, Russia, Serbia, Slovenia, and Ukraine. We collected clinical, immunological, and genetic information for 122 patients from 109 families. The BTK gene was sequenced from the genomic DNA of patients with a high susceptibility to infection, almost no CD19(+) peripheral blood B cells, and low or undetectable levels of serum immunoglobulins M, G, and A, compatible with a clinical and immunological diagnosis of XLA. BTK sequence analysis revealed 98 different mutations, 46 of which are reported for the first time here. The mutations included single nucleotide changes in the coding exons (35 missense and 17 nonsense), 23 splicing defects, 13 small deletions, 7 large deletions, and 3 insertions. The mutations were scattered throughout the BTK gene and most frequently concerned the SH1 domain; no missense mutation was detected in the SH3 domain. The prevalence of XLA in ECE countries (total population 145,530,870) was found to be 1 per 1,399,000 individuals. This report provides the first comprehensive overview of the molecular genetic and demographic features of XLA in Eastern and Central Europe.

  18. Mutación de novo en el gen BTK en agammaglobulinemia ligada a X. Reporte de un caso del estado Mérida, Venezuela

    Directory of Open Access Journals (Sweden)

    Liliana Aboultaif Aboultaif

    2013-09-01

    Full Text Available Las inmunodeficiencias primarias (IDPs son un conjunto de enfermedades caracterizadas por defectos en el desarrollo y/o función del sistema inmune debido a anomalías genéticas en cualquiera de sus componentes. Las deficiencias de anticuerpos son las IDPs más comunes y dentro de estas la agammaglobulinemia congénita representa el 10%, siendo un 85% ligada al cromosoma X, existiendo también formas autosómicas recesivas. La agammaglobulinemia ligada a X (ALX consiste en la ausencia casi absoluta de linfocitos B, ocasionando incapacidad de sintetizar anticuerpos y una alta susceptibilidad a la adquisición de infecciones, con respuesta a vacunas disminuida o ausente. Se presenta el caso de un escolar masculino de 8 años de edad quien desde los 5 meses presentó infecciones a repetición principalmente por bacterias extracelulares encapsuladas. Estudios paraclínicos revelaron hipogammglobulinemia persistente con subpoblación de linfocitos B muy disminuida y conservación de linfocitos T en sangre periférica. El estudio molecular reportó la mutación R525X en el exón 16 del gen TirosinKinasa de Bruton (BTK en el paciente y su madre, más no en la abuela, lo que confirmó el diagnóstico de ALX y permitió concluir que se trataba de una mutación de novo en la madre. Actualmente recibe tratamiento con Inmunoglobulina por vía endovenosa, disminuyendo la frecuencia y severidad de episodios infecciosos. El diagnóstico precoz a través del reconocimiento de las señales de alarma de las IDPs, junto al tratamiento adecuado y vigilancia constante constituyen la mejor herramienta para el adecuado manejo de los pacientes con IDPs, logrando una disminución de los procesos infecciosos e inflamatorios y sus secuelas, así como también mejorar la calidad de vida y supervivencia. De novo mutation in BTK gene in X-linked agammaglobulinaemia. A case report in Mérida, Venezuela Abstract The Primary Immunodeficiencies (PIDs are a group of diseases

  19. A novel BTK gene mutation, c.82delC (p.Arg28 Alafs*5), in a Korean family with X-linked agammaglobulinemia

    Science.gov (United States)

    Lee, Jeongeun; Rhee, Minhee; Min, Taek Ki; Bang, Hae In; Jang, Mi-Ae; Kang, Eun-Suk; Kim, Hee-Jin; Pyun, Bok Yang

    2016-01-01

    X-linked agammaglobulinemia (XLA) is a hereditary humoral immunodeficiency that results from Bruton’s tyrosine kinase (BTK) gene mutations. These mutations cause defects in B-cell development, resulting in the virtual absence of these lymphocytes from the peripheral circulation. Consequently, this absence leads to a profound deficiency of lg all isotypes, and an increased susceptibility to encapsulated bacterial infections. A 15-month-old Korean boy presented with recurrent sinusitis and otitis media after 6 months of age, and had a family history of 2 maternal uncles with XLA. Laboratory tests revealed a profound deficiency of Ig isotypes, and a decreased count of CD19+ B cells in the peripheral circulation. Based on his family history and our laboratory test results, he was diagnosed with XLA. We performed BTK gene analysis of peripheral blood samples obtained from family members to confirm the diagnosis. Mutational analysis revealed a novel hemizygous frameshift mutation (c.82delC, p.Arg28Alafs*5), in the BTK gene. His mother and maternal grandmother were heterozygous carriers of this mutation and his two maternal uncles were hemizygous at the same position. After XLA diagnosis, intravenous immunoglobulin (400 mg/kg, monthly) treatment was initiated; recurrent sinusitis and otitis media were subsequently brought under control. To our knowledge, this is the first reported case of a Korean pedigree with a novel mutation in the BTK gene. PMID:28018445

  20. Mutation analysis of the gene encoding Bruton`s tyrosine kinase in a family with a sporadic case of X-linked agammaglobulinemia reveals three female carriers

    Energy Technology Data Exchange (ETDEWEB)

    Hagemann, T.L.; Kwan, Sau-Ping [Rush Medical School, Chicago, IL (United States); Assa`ad, A.H. [Children`s Hospital Medical Center, Cincinnati, OH (United States)

    1995-11-06

    Bruton`s tyrosine kinase (Btk) has been identified as the protein responsible for the primary immunodeficiency X-linked agammaglobulinemia (XLA). We and others have cloned the gene for Btk and recently reported the genomic organization. Nineteen exons were positioned within the 37 kb gene. With the sequence data derived from our genomic map, we have designed a PCR based assay to directly identify mutations of the Btk gene in germline DNA of patients with XLA. In this report, the assay was used to analyze a family with a sporadic case of XLA to determine if other female relatives carry the disease. A four base-pair deletion was found in the DNA of the affected boy and was further traced through three generations. With the direct identification of the mutations responsible for XLA, we can now diagnose conclusively the disease and identify the immunologically normal female carriers. This same technique can easily be applied to prenatal diagnosis in families where the mutation can be identified. 34 refs., 3 figs.

  1. B cell-specific lentiviral gene therapy leads to sustained B-cell functional recovery in a murine model of X-linked agammaglobulinemia.

    Science.gov (United States)

    Kerns, Hannah M; Ryu, Byoung Y; Stirling, Brigid V; Sather, Blythe D; Astrakhan, Alexander; Humblet-Baron, Stephanie; Liggitt, Denny; Rawlings, David J

    2010-03-18

    The immunodeficiency disorder, X-linked agammaglobulinemia (XLA), results from mutations in the gene encoding Bruton tyrosine kinase (Btk). Btk is required for pre-B cell clonal expansion and B-cell antigen receptor signaling. XLA patients lack mature B cells and immunoglobulin and experience recurrent bacterial infections only partially mitigated by life-long antibody replacement therapy. In pursuit of definitive therapy for XLA, we tested ex vivo gene therapy using a lentiviral vector (LV) containing the immunoglobulin enhancer (Emu) and Igbeta (B29) minimal promoter to drive B lineage-specific human Btk expression in Btk/Tec(-/-) mice, a strain that reproduces the features of human XLA. After transplantation of EmuB29-Btk-LV-transduced stem cells, treated mice showed significant, albeit incomplete, rescue of mature B cells in the bone marrow, peripheral blood, spleen, and peritoneal cavity, and improved responses to T-independent and T-dependent antigens. LV-treated B cells exhibited enhanced B-cell antigen receptor signaling and an in vivo selective advantage in the peripheral versus central B-cell compartment. Secondary transplantation showed sustained Btk expression, viral integration, and partial functional responses, consistent with long-term stem cell marking; and serial transplantation revealed no evidence for cellular or systemic toxicity. These findings strongly support pursuit of B lineage-targeted LV gene therapy in human XLA.

  2. X-linked agammaglobulinemia in a 10-year-old boy with a novel non-invariant splice-site mutation in Btk gene.

    Science.gov (United States)

    Maekawa, Kota; Yamada, Masafumi; Okura, Yuka; Sato, Yasumasa; Yamada, Yutaka; Kawamura, Nobuaki; Ariga, Tadashi

    2010-04-15

    X-linked agammaglobulinemia (XLA) is a primary immunodeficiency disease caused by mutations in the gene coding for Bruton's tyrosine kinase (Btk). Most XLA patients have severely reduced or absent peripheral blood B cells and serum immunoglobulins, since the expression or function of Btk, critical for the maturation of B cell lineages at pro-B and pre-B cell stages, is deficient. Early and accurate diagnosis of XLA is important, since the affected patients suffer from severe and recurrent infections unless they receive intravenous immunoglobulin (IVIG) replacement therapy. However, the diagnosis of XLA is not always easy because some patients have detectable ( approximately 2%) B cells in the peripheral blood and have significant levels of serum immunoglobulins. In this study, we report on a patient who was diagnosed with XLA at the age of 10years. The diagnosis was delayed due to near-normal levels of serum immunoglobulins, although he presented with severe and recurrent bacterial infections since the age of 1year. He was demonstrated to have a novel non-invariant splice-site mutation in intron 10 (IVS10 -11C-->A) of the Btk gene, which was not detected by the standard PCR-based mutation analysis. This mutation resulted in no detectable Btk expression. This case suggests that patients suffering from severe or recurrent bacterial infection should be suspected to have XLA even though they may have significant levels of serum immunoglobulins. Furthermore, significant levels of serum immunoglobulins in XLA patients do not necessarily mean less severe phenotype.

  3. Clinical manifestation and genetic testing of 1 case of X-linked agammaglobulinemia%X连锁无丙种球蛋白血症1例临床表现及基因检测

    Institute of Scientific and Technical Information of China (English)

    王会贞; 卫海燕; 陈永兴

    2014-01-01

    Objective To improve people’s awareness to X-linked agammaglobulinemia(XLA). Methods A retrospective analysis was carried out to research a patient with X-linked agammaglobulinemia by clinical manifestations and genetic testing. Results The patient had recurrent pneumonia and otitis media, and these diseases had family history in the patient's family. The efficacy of anti-infection treatment was poor in local hospital.The testing results showed that the levels of IgM, IgA and IgG lowered obviously and B cell lacked, while after anti-infection treatment and Intravenous injection of human immunoglobulin, IgM, IgA ,IgG and B cell all increased. Genetic testing indicated that the patient had Bruton's agammaglobulinemia tyrosine kinase (BTK) mutations. Conclusion The clinical manifestations of XLA are repeated infection. The diagnosis of XLA mainly dependent on clinical manifestations and test of gamma globulin, while the mutation of BTK gene needs further study.%目的:提高对X连锁无丙种球蛋白血症的认识。方法通过1例X连锁无丙种球蛋白血症患者的临床表现、基因检测进行回顾性分析。结果患儿有反复肺炎、中耳炎病史,有家族史。当地予抗感染治疗疗效差。查IgM、IgA、IgG明显降低, B细胞缺乏,给予抗感染及静注人免疫球蛋白治疗后查IgM、IgA、IgG、B细胞升高。基因检测结果提示患儿存在BTK基因突变。结论 X连锁无丙种球蛋白血症临床常表现为反复感染,本病诊断多依赖临床和血丙种球蛋白测定, BTK基因突变尚需进一步研究。

  4. Allogeneic stem cell transplantation for X-linked agammaglobulinemia using reduced intensity conditioning as a model of the reconstitution of humoral immunity

    Directory of Open Access Journals (Sweden)

    Kazuhiro Ikegame

    2016-02-01

    Full Text Available Abstract Background We herein report the first case of X-linked agammaglobulinemia (XLA that underwent allogeneic stem cell transplantation using reduced intensity conditioning (RIC. We chronologically observed the reconstitution of humoral immunity in this case. Case presentation The patient was a 28-year-old Japanese male with XLA who previously had life-threatening infectious episodes and was referred for the possible indication of allogeneic stem cell transplantation. After a thorough discussion within specialists from different backgrounds, we decided to perform allogeneic peripheral stem cell transplantation from his HLA-identical elder brother. Due to the non-malignant nature of XLA, we selected RIC consisting of fludarabine, cyclophosphamide, anti-thymocyte globulin, and 3 Gy of total body irradiation. Neutrophil engraftment was achieved on day 11 with complete donor chimerism. No major complications, except for stage 1 skin graft-versus-host disease, were observed. The patient was discharged on day 75 and has been followed as an outpatient without any infectious episodes for more than 500 days. Conclusions Regarding immune reconstitution, CD19+ cells, IgA, and IgM, which were undetectable before allogeneic stem cell transplantation (allo-SCT, started to increase in number 10 days after allo-SCT and continued to increase for more than 1 year. Anti-B antibodies appeared as early as day 10. Total IgG levels decreased after the discontinuation of IgG replacement and spontaneously recovered after day 350. However, most anti-viral IgG titers, except EB virus-virus capsid antigen IgG, disappeared after the discontinuation of IgG replacement. A seasonal vaccination to influenza was performed on day 148, with neither anti-influenza type A nor type B being positive after the vaccination. The transient transfer of allergic immunity to orchard grass was observed. Similar Bruton’s tyrosine kinase (BTK expression levels in monocytes and B

  5. X-Linked Agammaglobulinemia (XLA)

    Science.gov (United States)

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  6. Detection of a novel mutation in the SRC homology domain 2 (SH2) of Bruton`s tyrosine kinase and direct female carrier evaluation in a family with x-linked agammaglobulinemia

    Energy Technology Data Exchange (ETDEWEB)

    Schuster, V.; Seidenspinner, S.; Wolfgang Kreth, H. [Univ. of Wuerzburg (Germany)

    1996-05-03

    X-linked agammaglobulinemia (XLA) is an inherited immunodeficiency disease with a block in differentiation from pre-B to B cells resulting in a selective defect in the humoral immune response. Affected males have very low concentrations of serum immunoglobulins leading predominantly to recurrent bacterial infections beginning at age 6 to 18 months. The gene responsible for XLA was identified recently to encode a cytoplasmatic tyrosine kinase (Bruton`s tyrosine kinase, BTK). We have analyzed the BTK gene in a large family in which two brothers presented with the severe phenotype of XLA. Genomic DNA of affected boys and from healthy relatives was amplified by PCR with primers specific for the putative promoter region and for all 19 exons, including flanking intron boundaries, and subsequently screened for mutations using single strand conformation polymorphism (SSCP) analysis. Altered single strand band patterns were found using primers specific for exon 10, 15, and 18. Direct cycle-sequencing of these BTK segments detected two known polymorphisms in intron 14 and in exon 18. Sequencing of exon 10 from two boys with XLA demonstrated a novel point mutation in the SH2 domain of BTK. Direct identification of healthy female carriers in three generations was performed by amplification mutagenesis using PCR with a modified first primer. This method can easily be applied also to prenatal diagnosis. 25 refs., 3 figs.

  7. 8例非Bruton酪氨酸激酶基因突变无丙种球蛋白血症患儿临床特征和基因突变/多态性分析%Clinical characteristics and genetic proifles of non Bruton's tyrosine kinase gene mutation agammaglobulinemia

    Institute of Scientific and Technical Information of China (English)

    吴静; 张慧; 龚若兰; 陈同辛

    2015-01-01

    目的:分析8例非Bruton酪氨酸激酶(BTK)基因突变无丙种球蛋白血症患儿的临床特征和基因突变/多态性特点。方法以2005年1月至2010年12月于上海交通大学医学院附属上海儿童医学中心诊断为无丙种球蛋白血症但BTK基因未检测出突变的患儿为研究对象,分析其临床资料和实验室结果。Sanger法检测其常见致病基因,包括IGHM、IGLL1、CD79a和CD79b。结果共纳入8例患儿,男女比例为3:1,平均发病年龄(3.7±2.4)岁。所有患儿均有反复感染史,其中最为常见的是肺炎和上呼吸道感染。1例患儿检测出IGLL1基因突变,其他致病基因未明。结论非BTK基因突变无丙种球蛋白血症患儿常见呼吸系统感染,可通过基因分析进行确诊。%Objective We retrospectively reviewed 8 patients diagnosed as agammaglobulinemia but without Bruton's tyrosine kinase (BTK) gene mutation, summarized their clinical manifestations and genetic features.MethodWe collected 8 patients who were diagnosed as agammaglobulinemia but no BTK gene mutation found in Shanghai Children's Medical Center from January 2005 to December 2010, analyzed their clinical and laboratory data. PCR followed by direct sequencing to analyze four common disease causing genes includingIGHM,IGLL1,CD79a andCD79b.Results8 patients were diagnosed as non BTK gene mutation agammaglobulinemia, the ratio of male to female patients is 3:1. The mean age of onset was (3.7±2.4)years. All of the patients have long-term recurrent infections, the most common symptom were pneumonia and upper respiratory tract infection.IGLL1 gene deifciency was found in 1 patient, but the other mutations were still undetermined.Conclusions The respiratory infections were the most common symptom in non BTK gene mutation agammaglobulinemia patients. Gene mutation analysis could help to diagnose agammaglobulinemia.

  8. 先天性无丙种球蛋白血症μ重链基因突变一例%Analysis of mutation in heavy chain-μ(μHC) gene in a Chinese patient with congenital agammaglobulinemia

    Institute of Scientific and Technical Information of China (English)

    张志勇; 赵晓东; 王墨; 张宇; 赵耀; 杨锡强

    2010-01-01

    Objective Mutation in the heavy chain μ(μHC) gene causes a rare type of autosomal recessive agammaglobulinemia.Here we report the molecular and clinical characterization of a compound heterozygous mutation in the μHC gene in a patient with autosomal recessive agammaglobulinemia firstly from China.Method A one-year and ten-month-old male patient and his parents were enrolled in this study.No mutation was found in BTK gene.The μHC gene of the patient and his parents were amplified by polymerase chain reaction(PCR) from genomic DNA.Reverse transcription polymerase chain reaction(RT-PCR) was used to amplify the μHC transcripts.Sequencing was performed directly on the PCR products bidirectionally Results Since 8 months of age,the patient had had recurrent fever and persistent cough.He suffered an acute right hemiplegia at 11 months of age and swelling and pain of left hip joint and right knee joint at one year and eight months of age.Cerebrospinal fluid routine examination showed that total cell count was 18×10~6/L[normal range(0-15)×10~6/L],leukocyte count 7×10~6/L[(0-15)×10~6/L] and biochemical examination showed protein 0.14 g/L(0.15-0.45 g/L),glucose 4.68 mmol/L(2.44-4.44 mmol/L) and chloride 116.3 mmol/L(120-132 mmol/L).Mycobacterium bovis was identified negative by cerebrospinal fluid smear examination.No obvious abnormity was detected on skull CT examination.Hydrothorax examination showed that total coll count was 848×10~6/L,leukocyte count 785×10~6/L and protein 30.8 g/L (<30 g/L).Poliovims isolation from stool sample of the patient was negative.The serum inununoglobulin (Ig)profile was IgG 181 mg/L(normal range,5.09-10.09 g/L);IgM 28.8 mg/dl(400-1260 mg/dl) and IgA 22 ms/dl(310-670 mg/dl),IgE 4.6 U/ml(normal range<150 U/ml).There were no B-cells but normal percentage of T-cells(67%) and NK cells(32%) were present in the peripheral blood.The patient had a compound heterozygous mutation in the μHC gene:on one allele,there was an alternative splice

  9. X连锁无丙种球蛋白血症的临床特点及基因检测%The clinical features of X-linked agammaglobulinemia and gene testing

    Institute of Scientific and Technical Information of China (English)

    赵培伟; 何学莲; 丁艳; 康世秀; 乐鑫; 李隽; 尹薇

    2013-01-01

    Objective To investigate the clinical features of X-linked agammaglobulinemia (XLA), and to explore the importance of genetic diagnosis to XLA. Methods The clinical features, laboratory examinations and genetic testing of a case of XLA were retrospectively analyzed. Meanwhile, the epidemiology and mechanisms, especially the genetic testing of XLA in the relevant literatures were reviewed. Results The XLA patient infected repeatedly with the clinical manifestations of pneumonia and bronchial pneumonia and had a progressive sensorineural deafness. The level of high-sensitivity C-reactive protein (hs-CRP) of the patient was increased (103 mg/L) and various immunoglobulins were decreased. The percentages of T lymphocyte cells were elevated. Both the percentage and the absolute number of CD19+B lymphocytes were zero. The results of genetic testing indicated that there was a large deletion including from exon7 to exonl9 of BTK gene, and the whole TIMM8A gene. Conclusions The clinical manifestation of the patient with XLA showed recurrent infections with decreased immunoglobulin and B lymphocytes in peripheral blood. Genetic testing of BTK gene is helpful for the clinical diagnosis.%目的 探讨X连锁无丙种球蛋白血症(XLA)的临床特点及检测其致病基因BTK的临床意义.方法 回顾性分析1例X连锁无丙种球蛋白血症的临床表现、实验室检查及基因检测的特点,同时复习XLA的流行病学及发病机制等相关文献,尤其是有关XLA基因检测的研究.结果 1例XLA患儿反复感染,表现为肺炎、急性支气管肺炎并伴有感音神经性耳聋.实验室检查,超敏C反应蛋白升高(103 mg/L),各种免疫球蛋白均下降,T淋巴细胞百分比升高,CD19+B淋巴细胞绝对值及百分比均为0.基因检测,BTK基因EXON7至EXON 19缺失,下游基因TIMM8A也缺失.结论 XLA患者临床表现为反复感染,免疫球蛋白下降,外周血B细胞下降.检测BTK基因可帮助临床诊断.

  10. 17例X-连锁无丙种球蛋白血症临床表型分析%Clinical features of 17 cases of X-linked agammaglobulinemia

    Institute of Scientific and Technical Information of China (English)

    贺建新; 赵顺英; 江载芳

    2008-01-01

    目的 分析17例单中心临床诊断的X连锁无丙种球蛋白血症(X-linked agammaglobulinemia,XLA)的临床表型特点.方法 2000年1月至2007年4月北京儿童医院住院患儿,根据临床反复感染表现、血IgG<2g/L、外周血成熟B淋巴细胞缺失或明显降低(<1%)诊断为XLA者,分析临床特点,总结规律.结果 首次诊断年龄平均为7.7岁,88.2%患儿首次诊断年龄>6岁.首次出现症状年龄平均为4.2岁,11.8%患儿首次出现症状年龄<1岁,17.6%患儿首次出现症状年龄为1~2岁.64.7%患儿首发症状为呼吸系统感染,大部分患儿均以此为主诉入院.35.3%患儿有关节炎表现.皮肤及软组织感染少见于<1岁年龄组.大年龄组患儿可出现突发败血症和/或深位部感染.结论 该组患儿发病年龄及首次诊断年龄均较迟,呼吸系统感染为最常见的主诉,关节炎的比例较高.>1/2的患儿血CD4+T细胞减少,CD8+T细胞增加,CD4/CD8比例倒置,NK细胞减少.

  11. Clinical features of 11 cases of X-linked agammaglobulinemia%11例X-连锁无丙种球蛋白血症临床特点分析

    Institute of Scientific and Technical Information of China (English)

    王佳; 韩晓华; 何蓉

    2012-01-01

    Objective To investigate the clinical features of X-linked agammaglobulinemia (XLA)in children,and to improve the early diagnostic rate.Methods The medical records of 11 children with XLA between Dec 2003 and Nov 2011 were reviewed.Results The smallest age of 11 cases with XLA presenting the first symptoms was 0.4 years old and the oldest age was 4 years old with a mean of 2.4 years old.The first diagnosis time was at the age of 3.5 to 13 years old,with a mean of 7 years old.The age at first diagnosis in 63.6% ( 7/11 ) of patients was more than 7 years old.Two patients ( 18.2% ) had the family history of the similar disease.Two patients were died from the infection and 1 patient was missed.The other 8 patients were survived.Respiratory infections occurred in 100% of the 11 patients.54.5% (6/11 )of the patients were suffered with otitis media and digestive infections were seen in 36.4% (4/11 ) of the patients.The levels of lgA,IgM and IgG in the serum of the pauents were all decreased.The levels of IgG in the serum of 9 patients were less than 2 g/L and in the serum of the other 2 patients were less than 2.4 g/L.The levels of CD19 in the serum were all less than 1% and an inversed ratio of CD4/CD8 was observed in 9 patients.Eight patients were diagnosed as XLA by gene detection.Conclusion The age presenting first symptoms in children with XLA in this study is earlier than the reported data and the age at first diagnosis is later.Respiratory infection is the most common manifestation.High prevalence of otitis media and digestive infections are common.The patients with XLA rarely have the family history.The early diagosis and long-term treatment with the intravenous immunoglobulin may improve the prognosis of XLA.%目的 总结X-连锁无丙种球蛋白血症(X-linked agammaglobulinemia,XLA)患儿的临床特点,提高对本病的早期诊断率.方法 回顾性分析2003年12月至2011年11月中国医科大学附属盛京医院住院的11例XLA患儿的

  12. X-连锁无丙种球蛋白血症患儿临床表型和基因诊断分析%Clinical Phenotype and Genetic Diagnosis Analysis of X-Linked Agammaglobulinemia

    Institute of Scientific and Technical Information of China (English)

    王艳琼; 崔玉霞; 王予川; 张志勇; 赵晓东; 蒋利萍

    2012-01-01

    Objective To analyze clinical phenotype characteristics and Bruton 's tyrosine kinase ( BTK) genetic variations of 3 cases of X -linked agammaglobuh'nemia(XLA) ,in order to improve the understanding of XLA among clinical physicians. Methods Based on clinical findings, 3 suspected XLA patients were confirmed by determining serum immunoglobulins levels, achroacyte subgroup expression,reverse transcriptase - polymerase chain reaction, the expression of BTK and gene analysis of BTK. Results The age of onset of all the 3 male patients were from 2 years and 2 months to 12 years and 6 months. The mean age at diagnosis was 6 years and 3 months. Recurrent infections were seen in all patients, such as otitis media, sinusitis, and repeatedly systemic pustules, pyothorax, suppurative arthritis,purulent meningitis. The prominent signs at diagnosis were dystrophia, growth and developmental retardation and markedly decreased or absent tonsils and lymph nodes. Concentration of all classes of serum immunoglobulins and the number of B cells in the peripheral circulation were drama-tically decreased. The 3 cases were found BTK gene mutation. Mothers of example 2,3 were carriers of the same genetic mutations. Conclusions The age at diagnosis of this reported group is older. Clinical symptoms display repeated suppurative bacterial infections of different parts. Based on the clinical manifestations, XLA patients can be diagnosed by further genetic analysis of BTK. It is good for finding BTK gene carriers and genetic consultation.%目的 分析3例X-连锁无丙种球蛋白血症(X-linked agammaglobulinemia,XLA)的临床表型特点及Bruton's酪氨酸激酶(BTK)基因变异情况,以提高临床医师对XLA的认识.方法 收集本组3例XLA患儿外周静脉血,测定其血清Ig水平和淋巴细胞亚群表达情况,采用RT-PCR和测序的方法分析患儿及母亲BTK基因变异情况,并总结其临床特征.结果 在临床特征方面3例均为男性患儿,

  13. Detection of Bruton's tyrosine kinase gene mutations and clinical analysis of 6 patients with X-linked agammaglobulinemia%六例X连锁无丙种球蛋白血症患儿BTK基因突变检测及临床分析

    Institute of Scientific and Technical Information of China (English)

    张晓敏; 李虹; 李强; 高举; 石晓青

    2014-01-01

    目的 研究Bruton酪氨酸激酶(Bruton,s tyrosine kinase,BTK)基因突变与X连锁无丙种球蛋白血症(X-linked agammaloglobulinemia,XLA)的临床表型的关系.方法 收集临床6例反复呼吸道感染并疑诊XLA的患儿病史、家族史、体格检查及辅助检查资料.采集患儿外周静脉血,PCR扩增BTK基因19个外显子及外显子与内含子连接区,PCR产物直接正反向测序并与GenBank中BTK基因序列进行比对确定有无BTK基因突变,及突变碱基和位置,以及相应的突变氨基酸及位点,对其中5例患儿的母亲DNA相应外显子进行基因测序确定是否为BTK基因突变携带者.结果 本组6例临床疑诊XLA的患儿均发现有BTK基因编码区突变,其中3例患儿突变发生在BTK基因酪氨酸激酶(the kinase domain,TK)功能区,2例在BTK基因血小板-白细胞C激酶底物同源区(pleckstrin homology,PH),1例在Src同源区2 (Src homology 2,SH2).突变类型在6例患儿中3例为错义突变[c.1105C>T(p.L369F),c.82C>T(p.R28C),c.1754T>C(p.V585A)];2例为无义突变[c.1834C>T(p.Q612X),c.37C>T(p.R13X)];1例为错义及移码复合突变[c.1802-1803TT>GC(p.F601C)及c.1803-1804insC (p.T602fsX603)];其中p.F601C、p.T602fsX603及p.V585A为未报道过的BTK基因新突变.在所检测的5例患儿母亲中有4例证实为BTK基因突变携带者,1例患儿母亲正常.结论 通过对6例临床拟诊XLA的患儿进行BTK基因突变检测,证实了患儿XLA的临床诊断,并发现3个新的BTK基因突变.及早进行基因诊断,规律地采用免疫球蛋白进行终身替代治疗可预防及治疗患儿感染、挽救患儿生命,并可发现携带者及进行遗传咨询.%Objective To explored the relationship between genotype of Bruton's tyrosine kinase (BTK) gene and X-linked agammaglobulinemia (XLA).Methods Six patients who were clinically suspected as XLA based on immunological results were studied.Peripheral blood samples were collected for DNA extraction

  14. 中国X连锁无丙种球蛋白血症40例基因型表型相关性分析%Characterization and correlation of genotype with phenotype of 40 cases of X-linked agammaglobulinemia in China

    Institute of Scientific and Technical Information of China (English)

    王莹; 应文静; 孙金峤; 刘丹如; 俞晔珩; 王静漪; 王晓川

    2012-01-01

    Objective To explore the phenotype-genotype correlation of X-linked agammaglobulinemia( XLA ) between clinical and immunological phenotypes and gene cDNA mutaions. Methods Using anti-BTK monoclone antibody the expression level of BTK protein was measured by flowcytometry. The BTK mutations in XLA patients were detected using PCR and direct sequencing. Some of the patients' mother and relatives were also taken BTK mutation analysis. Results ①Forty of 50 XLA patients were identified to have BTK gene mutation. The major types of BTK mutation were missense( 16 cases ) and nonsense mutations( 13 cases ). ②The age of onset of the XLA patients with missense mutations and other mutation were ( 1.4 ± 1. 1 ) and ( 1. 4 ± 0. 7 )years( P = 0. 45 ). The proportion of missense mutation increased, whereas the proportion of nonsense mutation decreased with the age of onset increasing. ③The numbers of circulating B cells of 34 cases( 85% ) were below 0. 1% ; 4 cases were between 1% and 2%. Among these 4 patients, two cases were missense mutation, one case was nonsense mutation and one case was splice-site mutation. Two cases with 2% B cells carried all missense mutiation. ④The major types of BTK mutation of the patients with low level of serum IgG( C ) in exon 18 may partly contribute to the clinical phenotype of arthritis.%目的 通过中国X连锁无丙种球蛋白血症(XLA)患儿临床表现、免疫功能评价、Bruton′s 酪氨酸激酶(BTK)的表达及BTK基因突变分析,分析基因型和表型间可能存在的关系.方法 选取拟诊为XLA患儿,使用抗BTK单克隆抗体通过流式细胞技术分析单核细胞BTK蛋白表达.采用RT-PCR获得患儿cDNA,使用8对不同引物分2步扩增BTK cDNA,PCR产物测序.突变结果 通过对DNA 外显子相应部位扩增、测序证实.并对确诊XLA患儿的母亲及家族中部分亲属进行BTK蛋白表达和BTK基因分析.结果 ①40/50例原发性低丙种球蛋白血症患儿经BTK基因突变分

  15. Neutrophil development and function critically depend on Bruton tyrosine kinase in a mouse model of X-linked agammaglobulinemia.

    Science.gov (United States)

    Fiedler, Katja; Sindrilaru, Anca; Terszowski, Grzegorz; Kokai, Enikö; Feyerabend, Thorsten B; Bullinger, Lars; Rodewald, Hans-Reimer; Brunner, Cornelia

    2011-01-27

    Bruton tyrosine kinase (Btk) is essential for B cell development and function and also appears to be important for myeloid cells. The bone marrow of Btk-deficient mice shows enhanced granulopoiesis compared with that of wild-type mice. In purified granulocyte-monocyte-progenitors (GMP) from Btk-deficient mice, the development of granulocytes is favored at the expense of monocytes. However, Btk-deficient neutrophils are impaired in maturation and function. Using bone marrow chimeras, we show that this defect is cell-intrinsic to neutrophils. In GMP and neutrophils, Btk plays a role in GM-CSF- and Toll-like receptor-induced differentiation. Molecular analyses revealed that expression of the lineage-determining transcription factors C/EBPα, C/EBPβ, and PU.1, depends on Btk. In addition, expression of several granule proteins, including myeloperoxidase, neutrophilic granule protein, gelatinase and neutrophil elastase, is Btk-dependent. In the Arthus reaction, an acute inflammatory response, neutrophil migration into tissues, edema formation, and hemorrhage are significantly reduced in Btk-deficient animals. Together, our findings implicate Btk as an important regulator of neutrophilic granulocyte maturation and function in vivo.

  16. Four mutations in SH2 and SH3 domains of Bruton`s tyrosine kinase (BTK) resulting in classic X-linked agammaglobulinemia (XLA)

    Energy Technology Data Exchange (ETDEWEB)

    Chen, S.H.; Zhang, M.; Zhu, Q.; Scott, C.R.; Och, H.D. [Univ. of Washington, Seattle, WA (United States)

    1994-09-01

    XLA is an X-linked immunodeficient disease in man resulted from mutations in the BTK gene. BTK contains a unique amino-region of unknown function, SH2 and SH3 (src homology) domains, and a carboxyl-terminal kinase (SH1) domain. We have studied the normal genomic organizations of the SH2 and SH3 domains and found the regions containing 6 exons are about 3000 bp in length. We also carried out sequence analyses of cDNA and genomic DNA of XLA patients to identify mutations. Four of fourteen families with XLA were found to have mutations within the regions. (1) A point mutation G to T in codon 240 resulted in a stop codon. (2) A transition mutation (g to a) at first nucleotide of intron 8 resulted in exon 8 skipping, missing 21 codons and shorter polypeptide but with normal kinase activity and ATP binding ability. (3) An a to t transversion at one of the invariant dinucleotides (ag) of the 3{prime} end of intron 11 resulted in alternative splicing at a position 13 nucleotides downstream from the normal one. The mutation produced mRNA with 13 nucleotide deletion and presumably resulted in a frameshift at codon 372 leading to a stop codon at 398. (4) A 16 nucleotide duplication (1248 to 1263 of the cDNA sequence) consistently present in mRNA of three brothers with XLA. However, genomic sequence of patient DNA of the regions did not reveal the anormaly. The observation that mutations within SH2 and SH3 causing severe B-cell defects typical for XLA suggests that these two domains are crucial for the function of BTK, possibly by regulating the interaction of cytoplasmic proteins involved in signal transduction.

  17. Progress in biological characteristics of Bruton's agammaglobulinemia tyrosine kinase%Bruton酪氨酸激酶Btk的生物学特性研究进展

    Institute of Scientific and Technical Information of China (English)

    李庆伟; 芦静; 刘欣

    2010-01-01

    酪氨酸激酶Btk是非受体酪氨酸家族的成员,它由PH结构域、TH结构域、SH3结构域、SH2结构域和催化结构域5部分组成.Btk参与多种信号通路,对细胞的增殖、分化和凋亡起着重要的调控作用.Btk的突变可导致X连锁无丙种球蛋白血症,一直以来都是研究热点.笔者将围绕Btk的结构、功能、X连锁无丙种球蛋白血症的临床表现等方面的内容加以综述,着重探讨Btk参与B细胞信号通路、TLR信号通路和肥大细胞脱颗粒等过程的具体机制.

  18. X连锁无丙种球蛋白血症一例误诊分析%A Misdiagnosed Case of X Linkage Agammaglobulinemia

    Institute of Scientific and Technical Information of China (English)

    涂明辉; 朱小燕

    2010-01-01

    @@ 1 病例资料 男,3岁.因左膝部疼痛、肿胀并功能障碍3 d收入骨科.病程中无发热、咳嗽.查体:精神稍差,咽稍红,心肺及腹部检查未见明显异常,双下肢无水肿.左膝肿胀、压痛,主、被动活动时疼痛加重,皮肤无发红,皮温不高,浮髌试验(+),肢端血液循环正常,余肢体无异常.入院诊断为左膝滑膜炎.查血常规、肝功能、肾功能、C反应蛋白均正常.左膝关节X线正位片示:左股骨远端骨骺边缘欠光整,未见骨质破坏,周围软组织明显肿胀.给予抗感染及对症治疗,症状无改善,患儿入院后反复高热、咳嗽,左膝关节局部皮肤搔抓后出现脓疱.行关节穿刺抽取关节腔积液检查:红细胞(++++),生化及细菌培养未见异常.

  19. Autosomal Recessive Hereditary Agammaglobulinemia%常染色体隐性遗传的无丙种球蛋白血症

    Institute of Scientific and Technical Information of China (English)

    王悦

    2005-01-01

    在原发性免疫缺陷病中,抗体介导的原发性B细胞缺陷的发生率占50%以上,其中X连锁无丙种球蛋白血症、选择性IgA缺陷、常见变异型免疫不全症等因其相对多见而被熟知.而常染色体隐性遗传的无丙种球蛋白血症也是能导致原发性B细胞缺陷的一类疾病,近10年来才在世界上引起重视并有病例报道.该文介绍了这类疾病的分类、病因、发病机制、诊断、治疗和预后等方面的特点,旨在呼吁儿科界关注此种疾病.

  20. Gene diagnosis of X-linked agammaglobulinemia%X连锁无丙种球蛋白血症的基因诊断

    Institute of Scientific and Technical Information of China (English)

    王晓川; 王莹; 金兼弘和; 宮脇利男; 俞晔珩

    2005-01-01

    目的研究我国X连锁无丙种球蛋白血症(XLA)患者Bruton's酪氨酸激酶(BTK)基因的突变类型.方法采用逆转录-聚合酶链反应(RT-PCR),获得7例XLA患者cDNA.使用8对不同引物分2步扩增BTK cDNA,PCR产物测序.突变结果通过对DNA外显子相应部位扩增、测序证实.对其中4例母亲进行基因分析.结果 7例患者的基因突变均位于BTK基因的编码区,3例在BTK的血小板-白细胞C激酶底物同源区,2例位于酪氨酸激酶区,其他2例分别位于Src同源区2和Src同源区3.突变包括:错义突变、无义突变、重复序列和片段缺失.除错义突变引起单一BTK氨基酸改变外,突变还分别造成终止密码子形成和阅读框架移位.其中4例为未见报道的新突变.进行基因分析的4例母亲中,3例为携带者.结论本组患者临床表现为典型XLA,检测出的7种突变均位于BTK基因编码区,其中4种是未见报道的新突变.XLA可以通过基因分析进行确诊以区别与其他低丙种球蛋白血症.

  1. Identification of Novel Molecular Targets for Pleckstrin Homology (PH) Domains Found in Oncogenes Implicated in Breast Cancer

    Science.gov (United States)

    2005-03-01

    which is mutated in X-linked agammaglobulinemia (XLA) [47, 48], and is the ’standard’ residue that is mutated to impair phosphoinositide binding by PH...I., CHAPMAN, V., PAUL, Biol. 1996, 255, 14-21. W E., Colocalization of X-linked 39 FUSHMAN, D., NAJMABADI-KASKE, T., agammaglobulinemia and X-linked

  2. Lymphocyte Changes in Normal Apheresis Donors

    Science.gov (United States)

    1983-01-01

    agammaglobulinemia and severe combined immunodeficiency disease. Changes in the relative numbers of T8+ T-cells (suppressors) also cause...cells are seen in immunodeficiency diseases. Patients with acquired agammaglobulinemia , recent viral "infections and lepromatous leprosy appear to have

  3. X-连锁无丙种球蛋白血症一例报告及文献复习%A retrospective study of one case of X-linked agammaglobulinemia

    Institute of Scientific and Technical Information of China (English)

    李德宪; 王晓川; 谭守勇; 劳穗华; 陈志宏; 王艳红; 李方知; 梁燕琼; 王娟

    2006-01-01

    目的 探讨X-连锁无丙种球蛋白血症的临床表现、诊断方法和治疗.方法 对1例21岁伴毛细血管扩张、B淋巴细胞减少、低丙种球蛋白血症(IgG 1.38 g/L,IgA 0.25 g/L, IgM 0.17 g/L)及反复肺部感染患者,用流式细胞仪检测患者及其母亲的单核细胞Bruton酪氨酸激酶(BTK)表达,并用逆转录-聚合酶链反应(RT-PCR)获得Cdna,PCR产物测序发现BTK基因突变,经相对应部位的DNA 序列PCR产物测序进一步证实.患者母亲DNA 也在相应部位扩增并测序.结果 患者及其母亲细胞内BTK表达分别为96.9%和97.8%.BTK基因点突变位于16 外显子(Cdna 1706 G>A),为错义突变(R525Q).患者母亲也被证实为携带者,存在相同的基因突变.经高剂量免疫球蛋白替代治疗(2 g/kg),1个月后IgG上升至5.79 g/L,临床症状、肺功能及影像学表现均明显改善,毛细血管扩张好转.结论 明确了1例伴毛细血管扩张的成人X-连锁无丙种球蛋白血症的基因诊断;高剂量免疫球蛋白替代治疗效果好.应提高医务人员对该病的认识.

  4. 基因突变致非遗传性X连锁无丙种球蛋白血症1例%A case with non-hereditary X-linked agammaglobulinemia caused by gene mutation

    Institute of Scientific and Technical Information of China (English)

    凌瑶君; 蔡家泉; 王红霞; 逯军

    2015-01-01

    目的 通过对1例基因突变致非遗传性X-连锁无丙种球蛋白血症病例进行观察分析,提高对X-连锁无丙种球蛋白血症临床和诊断特点的认识.方法 回顾性分析1例基因突变致非遗传性X-连锁无丙种球蛋白血症患者的临床表现及诊断过程,运用基因检测对诊断加以明确,并结合其他文献进行分析.结果 本例为男性,6岁,有反复“中耳炎”、“上呼吸道感染”、“支气管炎”、“肺炎”等病史,无家族史,基因检测显示患者BTK基因17外显子存在错义突变,而其母亲BTK基因检测未见异常,明确诊断为非遗传性X连锁无丙种球蛋白血症,予以IVIG治疗后,患儿症状明显好转.结论 X连锁无丙种球蛋白血症可为非遗传性,可根据反复感染的临床特点及BTK基因检测诊断该疾病.

  5. Review of nine cases of X-linked agammaglobulinemia%X连锁无丙种球蛋白血症9例报告并文献复习

    Institute of Scientific and Technical Information of China (English)

    孙立锋; 鞠云飞; 蒋利萍; 冯益真; 王金荣

    2010-01-01

    目的 探讨X连锁无丙种球蛋白血症(XLA)的临床表现、实验室检查特点、治疗及预后.方法 本文对2005年11月至2009年8月在我院确诊的9例XLA患儿的外周血免疫球蛋白及细胞表面分子进行检测,并结合临床症状及体征进行分析,对2例患儿进行Bruton酪氨酸激酶(BTK)基因测序分析.结果 本组9例患儿均有反复上呼吸道感染和肺炎,其中迁延难愈的中耳炎(3/9)及化脓性关节炎(4/9)多见,皮肤感染(1/9)、双下肢瘫痪(1/9)、扩张性心肌病(1/9)、慢性腹泻(1/9)、多关节炎(1/9)可见.诊断时除1例有明显的生长发育落后外,其余患儿发育正常.外周淋巴结及扁桃体较小或难以查到.实验室检查外周血免疫球蛋白<1.5 g/L和循环B细胞数<1%.其中2例患儿及母系亲属经BTK基因分析证实存在突变.结论 XLA可防可治,规范治疗,预后较好.

  6. Three cases report and literature review of X-Linked agammaglobulinemia%X-连锁无丙种球蛋白血症3例报告并文献复习

    Institute of Scientific and Technical Information of China (English)

    李小琳; 付四毛; 刘玉玲; 张莉; 林国模; 潘晓芬

    2014-01-01

    Objective To analyze the clinical features, diagnosis and treatment of X-Linked Agarnmaglobulinemia (XLA). Methods Clinical features, cellular and humoral immune functions, treatment and prognosis from 3 patients with XLA were retrospectively reviewed. Results The age of onset were from 11 months to 6 years in these 3 cases, however, the median age of diagnosis was 12 years. All patients showed multiple recurrent bacterial infections, arthritis involved large joints such as knee, ankle, elbow and hip. Laboratory examination revealed the decrease of serum gammmaglohulin and absence of B lymphocytes in the peripheral blood. All 3 patients were identiifed BTK mutations, which were frameshift mutation and nonsense mutation in exon 3, frameshift mutation in exon 10, missense mutation in exon 18. After XLA was diagnosed, the patients were managed by intravenous gammagloulin (IVIG) replacement. The non-steroidal anti-inflammatory drugs (NSAIDs) were administrated in patients combined arthritis. The small dose of hormones had been applied. All patients had a significantly improvement. Conclusions The clinical features of XLA have greater variability, with recurrent bacterial infections. Markedly decreased and absent tosils and lymph nodes, serum immunoglobulin may be one of the warning signs for early diagnosis of XLA. IVIG and NSAIDs can be jointly treatment of XLA with arthritis. The steroid and immunosuppressant agents should be used with caution.%目的:分析X-连锁无丙种球蛋白血症(XLA)的临床表现、诊断和治疗特点。方法回顾性分析3例XLA患儿的临床特点、细胞免疫、体液免疫指标及治疗和预后。结果3例XLA患儿的发病年龄自11个月至6岁,中位诊断年龄为12岁。患儿均表现为多发反复细菌感染;关节炎症累及膝、踝、肘和髋等大关节。实验室检查提示血清免疫球蛋白水平及循环B细胞明显降低。3例患儿均发现存在BTK基因突变,分别为外显子3的移码突变及无义突变,外显子10的移码突变,以及外显子18的错义突变。确诊为XLA后予静脉滴注丙种球蛋白(IVIG)替代治疗;合并关节炎加用非甾体类抗炎药物(NSAIDs),酌情加用小剂量激素,病情得到明显改善。结论 XLA临床表现具有较大的变异性,反复不同部位的细菌感染,扁桃体、淋巴结发育不良及血清免疫球蛋白水平低下是早期诊断XLA的重要环节;XLA合并关节炎使用IVIG和NSAIDs联合治疗,谨慎使用激素或免疫抑制剂。

  7. 性联无丙种球蛋白血症的Btk蛋白表达的研究%Study on Bruton's tyrosine kinase protein expression in children with X-linked agammaglobulinemia

    Institute of Scientific and Technical Information of China (English)

    黄海; 黄冬生; 洪建; 沈蕾; 应大明; 顾友梅

    2002-01-01

    通过对8例性联低丙球血症(XLA)患儿Btk蛋白表达的研究,了解Btk蛋白表达缺陷与XLA的相关性.应用蛋白印迹技术,观察患儿及对照组儿童Btk蛋白表达条带分布情况,结果发现正常儿Btk蛋白表达正常,而XLA者则有Btk蛋白表达缺陷.提示测定Btk蛋白表达情况对XLA的诊断有重要意义.

  8. Clinical and genetic analysis of 10 cases with X-linked agammaglobulinemia%10例X连锁无丙种球蛋白血症的临床分析和基因诊断

    Institute of Scientific and Technical Information of China (English)

    张志勇; 赵晓东; 王墨; 蒋利萍; 崔玉霞; 赵耀; 安云飞; 杨锡强

    2009-01-01

    目的 通过对X连锁无丙种球蛋白血症(XLA)患儿Bruton's酪氨酸激酶(BTK)基因变异和临床特征的分析,提高临床医师对XLA的认识.方法 收集2008年2月至2008年12月在我院住院的10例XLA患儿外周静脉血,采用RT-PCR方法扩增BTK cDNA,PCR产物直接双向测序.突变结果经DNA相应外显子部位扩增、测序进一步证实.结果 10例XLA患儿中7例患儿发现有BTK基因突变.6例位于编码区,1例位于内含子区.突变类型包括错义突变3例,无义突变1例,缺失2例和内含子剪接位点突变1例.其中5例(F583L,135Nfs177X,R123X,C502Y,IVS9+2T>C)为首次报道的新型突变.进行基因分析的6例XLA患儿母亲均为携带者.结论 BTK基因分析有助于XLA患儿的进一步明确诊断,而且有利于发现携带者和进行遗传咨询.

  9. X-连锁无丙种球蛋白血症合并幼年特发性关节炎%Juvenile idiopathic arthritis in patients with X-linked agammaglobulinemia

    Institute of Scientific and Technical Information of China (English)

    王晓川

    2003-01-01

    目的探讨X-连锁无丙种球蛋白血症(XLA)合并幼年特发性关节炎(JIA)的临床表现、诊断和治疗的特点.方法与结果3例患儿在婴幼儿期即开始发生反复感染,随后出现关节炎症表现,之后反复多次发生关节炎症和关节外感染.关节炎症累及膝、踝、肘和髋等大关节,个别伴有肝脏肿大.实验室检查:血清丙种球蛋白明显低下,外周血B细胞缺如.确诊为XLA后予静脉滴注丙种球蛋白(IVIG)和非甾体类抗炎药物(NSAIDs),病情得到迅速控制,关节未发生进一步损害.结论用IVIG和NSAIDs治疗XLA合并的JIA,可有效控制JIA的临床症状.谨慎使用激素或免疫抑制剂.

  10. Heterogeneous clinical presentation in ICF syndrome: correlation with underlying gene defects.

    NARCIS (Netherlands)

    Weemaes, C.M.R.; Tol, M.J. van; Wang, J.; Ostaijen-ten Dam, M.M. van; Eggermond, M.C. van; Thijssen, P.E.; Aytekin, C.; Brunetti-Pierri, N.; Burg, M. van der; aham Davies, E. Gr; Ferster, A.; Furthner, D.; Gimelli, G.; Gennery, A.; Kloeckener-Gruissem, B.; Meyn, S.; Powell, C.; Reisli, I.; Schuetz, C.; Schulz, A.; Shugar, A.; Elsen, P.J. van den; Maarel, S.M. van der

    2013-01-01

    Immunodeficiency with centromeric instability and facial anomalies (ICF) syndrome is a primary immunodeficiency, predominantly characterized by agammaglobulinemia or hypoimmunoglobulinemia, centromere instability and facial anomalies. Mutations in two genes have been discovered to cause ICF syndrome

  11. X-连锁无丙种球蛋白血症家系BTK基因突变分析及产前诊断研究%Mutation analysis and prenatal diagnosis in families of X-linked agammaglobulinemia caused by BTK gene mutation

    Institute of Scientific and Technical Information of China (English)

    孔祥东; 莫桂玲; 刘宁; 田培超; 陈敏芳

    2014-01-01

    目的 对X-连锁无丙种球蛋白血症(XLA)家系进行致病基因突变分析及产前诊断.方法 收集2011年1月至2012年6月在郑州大学第一附属医院就诊的3个XLA家系成员的外周血标本,应用PCR扩增和直接测序方法对3例XLA患者进行Bruton酪氨酸激酶(BTK)基因测序,分析BTK基因外显子区和剪切区DNA序列改变情况,采用PROVEN、PolyPhen-2和ClustalO软件对新发现的错义突变进行功能预测.在确定每个家系基因型后,对家系2和家系3中的2个高危胎儿抽取绒毛进行产前诊断.结果 家系1中,先证者及其母亲携带BTK基因c.1117C >A(p.L373I)错义突变,采用功能预测软件分析为致病突变的可能性大;家系2中,先证者及其母亲携带BTK基因c.126T>G(p.Y42X)无义突变;家系3中,先证者及其母亲携带c.1679delC(p.P560fsX10)缺失突变.3个XLA家系发现的3种BTK基因突变为新突变,100名健康个体BTK基因相应区域测序,未发现有上述同样序列改变.对明确致病突变的家系2和家系3胎儿行孕早期产前诊断,家系2胎儿为p.Y42X女性杂合突变携带者,家系3胎儿为男性未携带突变基因者,2对夫妇均选择继续妊娠,胎儿娩出后随访结果与产前诊断结果一致.结论 发现3个BTK基因新变异,BTK基因p.Y42X和p.P560fsX10突变是家系2和家系3患者的致病原因,BTK基因p.L373I突变可能是家系1患者致病的主要原因,但需要功能验证.对于有XLA生育史的夫妇再次生育时,应用基因测序技术行产前BTK基因突变分析可以有效地预防患儿出生.%Objective To evaluate the genetic diagnostic feasibility of Bruton's tyrosine kinase (BTK) gene in three families with X-linked agammagobulinemia (XLA) birth history,mutation analysis and prenatal genetic diagnosis of BTK gene for two families with XLA.Methods Polymerase chain reaction (PCR) was applied to amplify the regions of exon and exon-intron boundaries of BTK gene in 3 unrelated patients of XLA and their mothers from January 2011 to June 2012.The PCR products were further analyzed by direct sequencing.Prenatal genetic diagnosis was performed by chorionic villus sampling after genotyping of mothers of probands.Results Three novel mutations of BTK gene were identified in 3 pedigrees of XLA.A missense mutation c.1117C > A(p.L373I)were detected in pedigree 1.The mutation was possible damage by predicting in sillico.A nonsense mutation c.126T > G(p.Y42X)was found in pedigree 2.A single base deletion mutation c.1679delC(p.P560fsX10)was found in pedigree 3.The three mutations,p.L373I,p.Y42X and p.P560fsX10 were novel.The three novel mutations were absent in the 100 normal controls.The male fetus in pedigree 3 was free of mutations identical to the proband and the female fetus in pedigree 2 was a carrier.The two families continued the pregnancies and the infants showed no symptom of XLA after one year old.Conclusions Three novel mutations were identified.The mutations of p.Y42X and p.P560fsX10 in BTK gene may be the major causes of pedigrees 2 and 3 with XLA.The mutation p.L373I of BTK gene is possibly the cause of pedigree 1 with XLA,but functional verification is needed.For pedigree of XLA,direct sequencing of BTK gene is available for providing genetic counseling,prenatal diagnosis.

  12. Inflammatory Duodenal Polyposis Associated with Primary Immunodeficiency Disease: A Novel Case Report

    Science.gov (United States)

    Shera, Irfan Ali; Khurshid, Sheikh Mudassir

    2017-01-01

    Agammaglobulinemia is a rare form of B-cell primary immunodeficiency disease characterized by reduced levels of IgG, IgA, or IgM and recurrent bacterial infections. Agammaglobulinemia is most commonly associated with diffuse nodular lymphoid hyperplasia. Duodenal polyps are a rare entity; however, due to wide use of esophagogastroduodenoscopy, incidental diagnosis of duodenal polyps appears to be increasing. Although inflammatory duodenal polyposis has been reported in the literature, its association with common variable immunodeficiency has not been reported till date to the best of our knowledge. We report a case of a 59-year-old male with chronic symptoms of agammaglobulinemia associated with inflammatory duodenal polyposis. PMID:28163721

  13. Inflammatory Duodenal Polyposis Associated with Primary Immunodeficiency Disease: A Novel Case Report

    Directory of Open Access Journals (Sweden)

    Irfan Ali Shera

    2017-01-01

    Full Text Available Agammaglobulinemia is a rare form of B-cell primary immunodeficiency disease characterized by reduced levels of IgG, IgA, or IgM and recurrent bacterial infections. Agammaglobulinemia is most commonly associated with diffuse nodular lymphoid hyperplasia. Duodenal polyps are a rare entity; however, due to wide use of esophagogastroduodenoscopy, incidental diagnosis of duodenal polyps appears to be increasing. Although inflammatory duodenal polyposis has been reported in the literature, its association with common variable immunodeficiency has not been reported till date to the best of our knowledge. We report a case of a 59-year-old male with chronic symptoms of agammaglobulinemia associated with inflammatory duodenal polyposis.

  14. XLA patients with BTK splice-site mutations produce low levels of wild-type BTK transcripts.

    NARCIS (Netherlands)

    Noordzij, J.G.; Bruin-Versteeg, S. de; Hartwig, N.G.; Weemaes, C.M.R.; Gerritsen, E.J.; Bernatowska, E.; Lierde, S. van; Groot, R. de; Dongen, J.J.M. van

    2002-01-01

    X-linked agammaglobulinemia is caused by mutations in the BTK gene, which result in a precursor B-cell differentiation arrest in the bone marrow and the absence of or strongly reduced B lymphocytes in blood. We identified a patient with a mild clinical phenotype, low numbers of B lymphocytes, and a

  15. Allogeneic Bone Marrow Transplantation in Patients With Primary Immunodeficiencies

    Science.gov (United States)

    2009-10-14

    Immunologic Deficiency Syndromes; Chediak-Higashi Syndrome; Common Variable Immunodeficiency; Graft Versus Host Disease; X-Linked Lymphoproliferative Syndrome; Familial Erythrophagocytic Lymphohistiocytosis; Hemophagocytic Lymphohistiocytosis; X-linked Agammaglobulinemia; Wiskott-Aldrich Syndrome; Chronic Granulomatous Disease; X-linked Hyper IgM Syndrome; Severe Combined Immunodeficiency; Leukocyte Adhesion Deficiency Syndrome; Virus-Associated Hemophagocytic Syndrome

  16. Immune Disorder HSCT Protocol

    Science.gov (United States)

    2016-11-01

    Immune Deficiency Disorders; Severe Combined Immunodeficiency; Chronic Granulomatous Disease; X-linked Agammaglobulinemia; Wiskott-Aldrich Syndrome; Hyper-IgM; DiGeorge Syndrome; Chediak-Higashi Syndrome; Common Variable Immune Deficiency; Immune Dysregulatory Disorders; Hemophagocytic Lymphohistiocytosis; IPEX; Autoimmune Lymphoproliferative Syndrome; X-linked Lymphoproliferative Syndrome

  17. Hoffman syndrome: New patients, new insights.

    Science.gov (United States)

    Hügle, Boris; Hoffman, Hal; Bird, Lynne M; Gebauer, Corinna; Suchowerskyj, Philipp; Sack, Ulrich; Kohlhase, Jürgen; Schuster, Volker

    2011-01-01

    Hypogammaglobulinemia or agammaglobulinemia are major features of specific syndromes, including X-linked agammaglobulinemia and common variable immunodeficiency. However, the combination of hypogammaglobulinemia with specific dysmorphic features is less common, with only a few reported cases. One such report was a sporadic case of humoral immunodeficiency, facial dysmorphism, and limb anomalies in a young girl, later referred to as Hoffman syndrome. We report on a 7-year-old girl with almost complete loss of B cells, facial dysmorphism, and malformation of the limbs and genitalia, whose mother shows similar dysmorphic features with an attenuated version of the B-cell deficiency. We believe that all three cases described above represent the same condition. The features of the three affected individuals with Hoffman syndrome are reviewed. Further investigations in this recently recognized B-cell immunodeficiency syndrome are warranted.

  18. X-连锁无丙种球蛋白血症研究现状与展望

    Institute of Scientific and Technical Information of China (English)

    张宁; 宋淑嫒

    2004-01-01

    X-连锁无丙种球蛋白血症(X-Linked Agammaglobulinemia,XLA)属于原发性体液免疫缺陷病,由于Btk基因突变导致B细胞发育障碍,所以不能产生免疫球蛋白.本文对BTK的遗传学特性、基因突变分析及分子致病机制进行综述.

  19. [Clinic of humoral primary immunodeficiencies in adults. Experience in a tertiary hospital].

    Science.gov (United States)

    Cambray-Gutiérrez, Julio César; Herrera-Sánchez, Diana Andrea; Blancas-Galicia, Lizbeth; O'Farrill-Romanillos, Patricia María

    2016-01-01

    Antecedentes: Las inmunodeficiencias primarias (IDP) son trastornos de los componentes del sistema inmune. Las deficiencias humorales representan el 50%. Las más comunes son el déficit selectivo de IgA, agammaglobulinemia de Bruton y la inmunodeficiencia común variable (IDCV). Objetivo: Describir las características epidemiológicas y clínicas de adultos con IDP humorales, atendidos en una Clínica de Inmunodeficiencias Primarias Humorales. Métodos: Estudio descriptivo trasversal que abarcó un año de análisis, en el que se incluyeron 35 pacientes con IDP humoral. Los datos se analizaron con estadística descriptiva. Resultados: De 35 pacientes estudiados, 31 tuvieron IDCV (88.5%) y 4 (11.5%) agammaglobulinemia de Bruton; 21 fueron hombres y 14 mujeres. La edad al inicio de los síntomas fue de 22.7 años y el tiempo de retraso en el diagnóstico fue de 7.2 años; 11.4% de los pacientes con IDCV fallecieron durante el estudio; 4 padecieron neoplasias, 22.8% enfermedades autoinmunes y 48.5% alteraciones gastrointestinales. Los pacientes con agammaglobulinemia de Bruton no presentaron comorbilidades. Conclusiones: A diferencia de lo informado en la literatura, la IDCV fue la causa más común de IDP humoral en el grupo estudiado, con predominio en hombres; la alteración gastrointestinal más común fue el trastorno funcional intestinal.

  20. DEVELOPMENT OF REAL-TIME MULTIPLEX PCR FOR THE QUANTITATIVE DETERMINATION OF TREC'S AND KREC'S IN WHOLE BLOOD AND IN DRIED BLOOD SPOTS

    Directory of Open Access Journals (Sweden)

    M. A. Gordukova

    2015-01-01

    Full Text Available Primary immunodeficiencies (PID such as severe combined immunodeficiency (SCID and X-linked agammaglobulinemia are characterized by the lack of functional Tand B-cells, respectively. Without early diagnosis and prompt treatment children with PID suffer from severe infectious diseases, leading to their death or disability. Our purpose was developing of simple, inexpensive, high throughput technique based on the quantitative determination of TREC and KREC molecules by real-time PCR, and its validation in a group of children with a verified diagnosis of SCID and X-linked agammaglobulinemia.In this study, we developed and validated multiplex real-time PCR for the TREC’s and KREC’s quantitative analysis. We have shown that linear range of Ct changes depending on the concentrations of targets with a correlation coefficient R2 not worse than 0.98 was observed at concentrations from 109 to 5 × 104 copies per ml. The lowest amount of targets reliably detected in a reaction volume was 10 TREC’s copies, 5 KREC ‘s copies and 5 copies of internal control (IL17RA. We determined the age-depended reference values of TRECs and KRECs in whole blood in 29 boys and 27 girls with normal immunological parameters. The normal cut-offs for TRECs and KRECs were defined in dry blood spots depending on the method of extraction.The proposed method showed 100% diagnostic sensitivity and specificity in the studied group. The method can be proposed as a screening tool for the diagnosis of SCID and X-linked agammaglobulinemia both in whole blood and in the dry blood spots. The further investigation is required with larger number of samples. 

  1. Current Perspectives on Primary Immunodeficiency Diseases

    Directory of Open Access Journals (Sweden)

    Arvind Kumar

    2006-01-01

    Full Text Available Since the original description of X-linked agammaglobulinemia in 1952, the number of independent primary immunodeficiency diseases (PIDs has expanded to more than 100 entities. By definition, a PID is a genetically determined disorder resulting in enhanced susceptibility to infectious disease. Despite the heritable nature of these diseases, some PIDs are clinically manifested only after prerequisite environmental exposures but they often have associated malignant, allergic, or autoimmune manifestations. PIDs must be distinguished from secondary or acquired immunodeficiencies, which are far more common. In this review, we will place these immunodeficiencies in the context of both clinical and laboratory presentations as well as highlight the known genetic basis.

  2. 原发性免疫缺陷病的历史、现状和展望%History, status quo and expectation of primary immunodeficiency

    Institute of Scientific and Technical Information of China (English)

    杨锡强

    2004-01-01

    早在1940年学者们就认识到一些疾病与感染密切相关,但并未认识到这些病例存在免疫功能异常。1952年Bruton报道了首例先天性无丙种球蛋白血症(congenital agammaglobulinemia),从此免疫缺陷(immunodeficiency)一词开始被广泛使用。此后几乎每年均有新的原发性免疫缺陷病(primary immunodeficiency,PID)被发现.

  3. Bruton’s Disease Presenting With Arthritis; A Case Report

    Directory of Open Access Journals (Sweden)

    Ramezanali Yakhchali

    2015-06-01

    Full Text Available Introduction X-linked Agammaglobulinemia (XLA is one of the primary humoral immunodeficiencies. It usually presents symptoms of recurrent infections, but in some unusual cases it may present rheumatologic manifestations. Case Presentation The current paper presents the cases of two boys with arthritis treated for juvenile rheumatoid arthritis (JRA without proper responses. Addition of some recurrent infections in the course of their disease led to work-up them for immunodeficiencies. Conclusions According to the results of these work-ups, XLA was diagnosed for the cases.

  4. Drug: D10223 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available D10223 Drug Ibrutinib (USAN); Imbruvica (TN) C25H24N6O2 440.1961 440.4971 D10223.gi...cell receptor signaling pathway USP drug classification [BR:br08302] Antineoplastics Molecular Target Inhibitors Ibrutin...r08310] Protein kinases Tyrosine protein kinases Tec family Bruton agammaglobulinemia tyrosine kinase [HSA:695] [KO:K07370] Ibrutin...ib D10223 Ibrutinib (USAN) CAS: 936563-96-1 PubChem: 163312254 ATOM 33 1 C8x C 18.410...ib D10223 Ibrutinib (USAN) Target-based classification of drugs [BR:b

  5. Combined immunodeficiency presenting with vaccine-associated paralytic poliomyelitis: a case report and narrative review of literature.

    Science.gov (United States)

    Shaghaghi, Mohammadreza; Parvaneh, Nima; Ostad-Rahimi, Pouya; Fathi, Seyed Mohammad; Shahmahmoodi, Shohreh; Abolhassani, Hassan; Aghamohammadi, Asghar

    2014-01-01

    Neurologic abnormalities compatible with vaccine-related poliovirus infection (VAPP) may be a first presentation of some primary immunodeficient patients. The risk of VAPP rises from 1 case per 750 000 in normal population to 1 per 7000 times higher, particularly for persons with agammaglobulinemia and hypogammaglobulinemia. However, there is no appropriate estimation for VAPP occurrence in patients with cellular immunity defects. Herein we report a case of combined immunodeficiency with paralytic complication due to oral polio vaccine and we present a literature review on this topic.

  6. XLA-associated neutropenia treatment: a case report and review of the literature.

    Science.gov (United States)

    Jacobs, Zachary David; Guajardo, Jesus Ramon; Anderson, Katherine Marie

    2008-08-01

    X-linked agammaglobulinemia (XLA) is a primary B-cell deficiency syndrome with an incidence of 5 to 10 cases per million. The current treatment approach includes intravenous immunoglobulin and aggressive antibiotic regimens for infections. Besides recurrent infections, XLA patients may present with other manifestations, such as alopecia, enteropathy, amyloidosis, and neutropenia. Neutropenia, which has been shown in up to 25% of affected patients, might also contribute to the degree of severity of bacterial infections that have been reported in these cases. Here we present our experience with the granulocyte colony-stimulant factor, filgrastim (Neupogen), in the treatment of neutropenia in a 14-month-old child with XLA.

  7. Prevalence of primary immunodeficiency in Korea.

    Science.gov (United States)

    Rhim, Jung Woo; Kim, Kyung Hyo; Kim, Dong Soo; Kim, Bong Seong; Kim, Jung Soo; Kim, Chang Hwi; Kim, Hwang Min; Park, Hee Ju; Pai, Ki Soo; Son, Byong Kwan; Shin, Kyung Sue; Oh, Moo Young; Woo, Young Jong; Yoo, Young; Lee, Kun Soo; Lee, Kyung Yil; Lee, Chong Guk; Lee, Joon Sung; Chung, Eun Hee; Choi, Eun Hwa; Hahn, Youn Soo; Park, Hyun Young; Kim, Joong Gon

    2012-07-01

    This study represents the first epidemiological study based on the national registry of primary immunodeficiencies (PID) in Korea. Patient data were collected from 23 major hospitals. A total of 152 patients with PID (under 19 yr of age), who were observed from 2001 to 2005, have been entered in this registry. The period prevalence of PID in Korea in 2005 is 11.25 per million children. The following frequencies were found: antibody deficiencies, 53.3% (n = 81), phagocytic disorders, 28.9% (n = 44); combined immunodeficiencies, 13.2% (n = 20); and T cell deficiencies, 4.6% (n = 7). Congenital agammaglobulinemia (n = 21) and selective IgA deficiency (n = 21) were the most frequently reported antibody deficiency. Other reported deficiencies were common variable immunodeficiencies (n = 16), X-linked agammaglobulinemia (n = 15), IgG subclass deficiency (n = 4). Phagocytic disorder was mostly chronic granulomatous disease. A small number of patients with Wiskott-Aldrich syndrome, hyper-IgE syndrome, and severe combined immunodeficiency were also registered. Overall, the most common first manifestation was pneumonia. This study provides data that permit a more accurate estimation PID patients in Korea.

  8. A 6. 5-Mb yeast artificial chromosome contig incorporating 33 DNA markers on the human X chromosome at Xq22

    Energy Technology Data Exchange (ETDEWEB)

    Vetrie, D.; Kendall, E.; Coffey, A.; Hassock, S.; Collins, J.; Todd, C.; Bobrow, M.; Bentley, D.R. (Paediatric Research Unit, London (United Kingdom)); Lehrach, H. (Imperial Cancer Research Fund, London (United Kingdom)); Harris, A. (John Radcliffe Hospital, Oxford (United Kingdom))

    1994-01-01

    The Xq22 region of the human X chromosome contains genes for a number of inherited disorders. Sixty-nine yeast artificial chromosome clones have been isolated and assembled into a 6.5-Mb contig that contains 33 DNA markers localized to this region. This contig extends distally from DXS366 to beyond DXS87 and includes the genes involved in X-linked agammaglobulinemia (btk), Fabry disease (GLA), and Pelizaeus-Merzbacher disease (PLP). The order of markers in this contig is consistent with the known genetic and physical mapping information of Xq22. This cloned material provides a source from which to isolate other genes located in this part of the X chromosome. 45 refs., 2 figs., 2 tabs.

  9. DNA Banking of Primary Immunodeficiency Disorders in Iran

    Directory of Open Access Journals (Sweden)

    "Anna Isaian

    2006-12-01

    Full Text Available Primary immunodeficiency disorders are a heterogeneous group of genetic disorders, with different modes of inheritance, consisting of more than 100 different types. We constructed the DNA banking of primary immunodeficiency disorders for the first time in Iran. The DNA of 31 immunodeficient patients and their families (total of 92 samples were collected, as the first step for construction of DNA banking. DNA was isolated from whole blood by salting out method. Among our patients, Common variable immunodeficiency was the most common disorder, followed by X-linked agammaglobulinemia, Ataxia-telangiectasia, Chronic granulomatous disease, Severe combined immunodeficiency, Hyper IgM syndromes, and Leukocyte adhesion defects. DNA banking is a useful method for further detection of mutation in immunodeficient patients and prenatal diagnosis for presence or absence of the disorder in the fetus which can be confirmed by molecular genetics testing.

  10. X-连锁无丙种球蛋白血症的研究进展

    Institute of Scientific and Technical Information of China (English)

    周琦; 张凯; 李学伟

    2006-01-01

    X-连锁无丙种球蛋白血症(X—linked agammaglobulinemia,XLA)属于原发性体液免疫缺陷病中的一种,又叫Bruton病。近年来,由于Bruton酪氨酸激酶(Bruton’s agammaglobulinemia tyrosine kinase,BTK)基因突变导致B细胞发育障碍,所以不能产生免疫球蛋白。本文就近年来对BTK的遗传学特性、基闪突变分析、分子致病机制及诊断和治疗等的研究进展作一综述。

  11. Advances in human genetics

    Energy Technology Data Exchange (ETDEWEB)

    Harris, H.; Hirschhorn, K. (eds.)

    1993-01-01

    This book has five chapters covering peroxisomal diseases, X-linked immunodeficiencies, genetic mutations affecting human lipoproteins and their receptors and enzymes, genetic aspects of cancer, and Gaucher disease. The chapter on peroxisomes covers their discovery, structure, functions, disorders, etc. The chapter on X-linked immunodeficiencies discusses such diseases as agammaglobulinemia, severe combined immunodeficiency, Wiskott-Aldrich syndrome, animal models, linkage analysis, etc. Apolipoprotein formation, synthesis, gene regulation, proteins, etc. are the main focus of chapter 3. The chapter on cancer covers such topics as oncogene mapping and the molecular characterization of some recessive oncogenes. Gaucher disease is covered from its diagnosis, classification, and prevention, to its organ system involvement and molecular biology.

  12. A Bad Case of Good's Syndrome.

    Science.gov (United States)

    Tachdjian, Raffi; Keller, Janet J; Pfeffer, Michael

    2014-12-01

    Good's syndrome is a relatively rare immunodeficiency condition that presents in the fourth or fifth decade of life and is defined by hypogammaglobulinemia in the setting of a thymoma. The humoral defect may be severe enough to cause an absence in B cells, with a consequent recurrence of sinopulmonary disease, chronic non-infectious diarrhea and opportunistic infections. The prognosis in patients with Good's syndrome appears to be worse than in those with X-linked agammaglobulinemia (XLA) and common variable immune deficiency (CVID). There have only been three cases of Good's syndrome associated with mycobacterium, and only one case with a cavitary lesion in the lungs. We present here a unique case of Good's syndrome with a non-mycobacterial cavitary lesion.

  13. Molecular and genetic basis of X-linked immunodeficiency disorders

    Energy Technology Data Exchange (ETDEWEB)

    Puck, J.M. (National Center for Human Genome Research, Bethesda, MD (United States))

    1994-03-01

    Within a short time interval the specific gene defects causing three X-linked human immunodeficiencies, agammaglobulinemia (XLA), hyper-IgM syndrome (HIGM), and severe combined immunodeficiency (XSCID), have been identified. These represent the first human disease phenotypes associated with each of three gene families already recognized to be important in lymphocyte development and signaling: XLA is caused by mutations of a B cell-specific intracellular tyrosine kinase; HIGM, by mutations in the TNF-related CD40 ligand, through which T cells deliver helper signals by direct contact with B cell CD40; and XSCID, by mutations in the [gamma] chain of the lymphocyte receptor for IL-2. Each patient mutation analyzed to date has been unique, representing both a challenge for genetic diagnosis and management and an important resource for dissecting molecular domains and understanding the physiologic function of the gene products.

  14. Acciones inmunofarmacológicas de las inmunoglobulinas intravenosas

    Directory of Open Access Journals (Sweden)

    Amaury Noda

    2001-03-01

    Full Text Available Se ha recorrido un largo camino en la comprensión de los mecanismos de acción relativos a la infusión de preparados de inmunoglobulinas intravenosas desde los días donde un crudo de fracción II de Cohn obtenido de plasma humano fue administrado intramuscularmente a pacientes aquejados de agammaglobulinemia de Brutton, hasta nuestros días. Debemos hacer una distinción entre los mecanismos de acción al nivel del patógeno que provoca la enfermedad, de aquellos al nivel de una enfermedad dada provocada por la reacción del huésped contra el patógeno. El efecto de supresión de las inmunoglobulinas intravenosas en las respuestas autoinmunes abre nuevas perspectivas terapéuticas y permite un nuevo acercamiento a la comprensión de los mecanismos básicos que explican la autoinmunidad patológica.

  15. Spondylarthritis in the absence of B lymphocytes.

    Science.gov (United States)

    Baeten, Dominique; Kruithof, Elli; Breban, Maxime; Tak, Paul P

    2008-03-01

    The highly effective treatment of rheumatoid arthritis by B cell depletion and the presence of B cells in the peripheral and axial lesions of patients with spondylarthritis (SpA) raise the question as to whether B lymphocytes could also be an appropriate therapeutic target in the latter disease. We describe 2 male HLA-B27-positive patients who had active SpA despite absence of B cells. One patient developed SpA with sacroiliitis and asymmetric oligoarthritis after having been diagnosed as having severe Bruton agammaglobulinemia. Since extensive investigations excluded an infectious origin of the SpA, this case illustrates that functional B cells and/or gamma globulins are not strictly required for SpA pathogenesis. The second patient had severe axial and peripheral SpA that was treated successfully with etanercept. After discontinuation of etanercept treatment because of non-Hodgkin's B cell lymphoma, both axial and peripheral SpA symptoms relapsed rapidly, and this exacerbation of articular disease activity was not modulated by successful B cell depletion therapy for the lymphoma. Although case reports have obvious limitations, our clinical observations provide evidence that active SpA can occur in the absence of functional mature B cells and thus emphasize the need for systematic studies of the exact role and function of B lymphocytes in this disease.

  16. Preclinical Evaluation of the Novel BTK Inhibitor Acalabrutinib in Canine Models of B-Cell Non-Hodgkin Lymphoma.

    Directory of Open Access Journals (Sweden)

    Bonnie K Harrington

    Full Text Available Acalabrutinib (ACP-196 is a second-generation inhibitor of Bruton agammaglobulinemia tyrosine kinase (BTK with increased target selectivity and potency compared to ibrutinib. In this study, we evaluated acalabrutinib in spontaneously occurring canine lymphoma, a model of B-cell malignancy similar to human diffuse large B-cell lymphoma (DLBCL. First, we demonstrated that acalabrutinib potently inhibited BTK activity and downstream effectors in CLBL1, a canine B-cell lymphoma cell line, and primary canine lymphoma cells. Acalabrutinib also inhibited proliferation in CLBL1 cells. Twenty dogs were enrolled in the clinical trial and treated with acalabrutinib at dosages of 2.5 to 20mg/kg every 12 or 24 hours. Acalabrutinib was generally well tolerated, with adverse events consisting primarily of grade 1 or 2 anorexia, weight loss, vomiting, diarrhea and lethargy. Overall response rate (ORR was 25% (5/20 with a median progression free survival (PFS of 22.5 days. Clinical benefit was observed in 30% (6/20 of dogs. These findings suggest that acalabrutinib is safe and exhibits activity in canine B-cell lymphoma patients and support the use of canine lymphoma as a relevant model for human non-Hodgkin lymphoma (NHL.

  17. Subcutaneous immunoglobulin replacement therapy in the treatment of patients with primary immunodeficiency disease

    Directory of Open Access Journals (Sweden)

    Suzanne Skoda-Smith

    2009-12-01

    Full Text Available Suzanne Skoda-Smith, Troy R Torgerson, Hans D OchsSeattle Children’s Research Institute and Department of Pediatrics, University of Washington, Seattle, WashingtonAbstract: Antibody deficiency is the most frequently encountered primary immunodeficiency disease (PIDD and patients who lack the ability to make functional immunoglobulin require life-long replacement therapy to prevent serious bacterial infections. Human serum immunoglobulin manufactured from pools of donated plasma can be administered intramuscularly, intravenously or subcutaneously. With the advent of well-tolerated preparations of intravenous immunoglobulin (IVIg in the 1980s, the suboptimal painful intramuscular route of administration is no longer used. However, some patients continued to experience unacceptable adverse reactions to the intravenous preparations, and for others, vascular access remained problematic. Subcutaneously administered immunoglobulin (SCIg provided an alternative delivery method to patients experiencing difficulties with IVIg. By 2006, immunoglobulin preparations designed exclusively for subcutaneous administration became available. They are therapeutically equivalent to intravenous preparations and offer patients the additional flexibility for the self-administration of their product at home. SCIg as replacement therapy for patients with primary antibody deficiencies is a safe and efficacious method to prevent serious bacterial infections, while maximizing patient satisfaction and improving quality of life.Keywords: subcutaneous immunoglobulin, primary immunodeficiency disease, antibody deficiency, X-linked agammaglobulinemia, common variable immune deficiency

  18. "The spectrum of primary immunodeficiency disorders in Iran "

    Directory of Open Access Journals (Sweden)

    "Aghamohammadi A

    2002-07-01

    Full Text Available Epidemiological studies have shown wide geographical and racial variation in the prevalence and patterns of immunodeficiency disorders. To determine the frequency of primary immunodeficiencies (PID in Iran, the Iranian primary Immunodeficiencies Registry (IPIDR was organized in 1999. the diagnosis of immunodeficiency in our patients was based on standard criteria. The patient’s data were extracted, by using a uniform questionnaire from their hospital records. Three hundred and twenty eight patients with PID have been registered in our registry till 2000. Among these patients, the following frequencies were found: predominantly antibody deficiency in 48.48% of patients (n=159, T-cell disorders in 25.91% (n=85, phagocytic disorders in 24.7% (n=81, and complement deficiencies in 0.91% (n=3. Common variable immunodeficiency was the most frequent disorder (n=73, followe by chronic granulomatous disease (n=55, ataxia telangiectasia (n=39, x-linked agammaglobulinemia (n=35, selective IgA deficiency (n=34. This study reveals that antibody deficiencies are the most frequent diagnosed primary immunodeficiency disorder in our patients, which is similar to that observed in other registries. A comparative study shows some differences between our results and other registries

  19. X连锁无丙种球蛋白血症并粒细胞缺乏症

    Institute of Scientific and Technical Information of China (English)

    王淑玉; 赵丽

    2013-01-01

    目的 探讨X连锁无丙种球蛋白血症(X linked agammaglobulinemia,XLA)的临床特点并分析误诊原因.方法 对我院收治的1例XLA并粒细胞缺乏症的临床资料进行回顾性分析.结果 本例为3.5岁男性患儿,因咳嗽9d、发热6d入院.于出生后6个月开始反复发热,先后诊断为扁桃体脓肿、支气管炎、重症肺炎、脓毒血症、化脓性中耳炎、皮肤软组织感染、手足口病等,多次查血常规示粒细胞明显降低.本次人院经免疫球蛋白及T、B细胞亚群检查,确诊为XLA并粒细胞缺乏症,予人丙种球蛋白治疗后临床治愈出院.结论 XLA发病率低,临床应提高对本病的认识,以便早期诊断并治疗.

  20. Methylation of HpaII and HhaI sites near the polymorphic CAG repeat in the human androgen-receptor gene correlates with X chromosome inactivation

    Energy Technology Data Exchange (ETDEWEB)

    Allen, R.C.; Zoghbi, H.Y.; Moseley, A.B.; Rosenblatt, H.M.; Belmont, J.W. (Baylor College of Medicine, Houston (United States))

    1992-12-01

    The human androgen-receptor gene (HUMARA; GenBank) contains a highly polymorphic trinucleotide repeat in the first exon. The authors have found that the methylation of HpaII and HhaI sites less than 100 pb away from this polymorphic short tandem repeat (STR) correlates with X inactivation. The close proximity of the restriction-enzyme sites to the STR allows the development of a PCR assay that distinguishes between the maternal and paternal alleles and identifies their methylation status. The accuracy of this assay was tested on (a) DNA from hamster/human hybrid cell lines containing either an active or inactive human X chromosome; (b) DNA from normal males and females; and (c) DNA from females showing nonrandom patterns of X inactivation. Data obtained using this assay correlated substantially with those obtained using the PGK, HPRT, and M27[beta] probes, which detect X inactivation patterns by Southern blot analysis. In order to demonstrate one application of this assay, the authors examined X inactivation patterns in the B lymphocytes of potential and obligate carriers of X-linked agammaglobulinemia. 42 refs., 5 figs., 1 tab.

  1. Primary B-cell deficiencies reveal a link between human IL-17-producing CD4 T-cell homeostasis and B-cell differentiation.

    Directory of Open Access Journals (Sweden)

    Rita R Barbosa

    Full Text Available IL-17 is a pro-inflammatory cytokine implicated in autoimmune and inflammatory conditions. The development/survival of IL-17-producing CD4 T cells (Th17 share critical cues with B-cell differentiation and the circulating follicular T helper subset was recently shown to be enriched in Th17 cells able to help B-cell differentiation. We investigated a putative link between Th17-cell homeostasis and B cells by studying the Th17-cell compartment in primary B-cell immunodeficiencies. Common Variable Immunodeficiency Disorders (CVID, defined by defects in B-cell differentiation into plasma and memory B cells, are frequently associated with autoimmune and inflammatory manifestations but we found no relationship between these and Th17-cell frequency. In fact, CVID patients showed a decrease in Th17-cell frequency in parallel with the expansion of activated non-differentiated B cells (CD21(lowCD38(low. Moreover, Congenital Agammaglobulinemia patients, lacking B cells due to impaired early B-cell development, had a severe reduction of circulating Th17 cells. Finally, we found a direct correlation in healthy individuals between circulating Th17-cell frequency and both switched-memory B cells and serum BAFF levels, a crucial cytokine for B-cell survival. Overall, our data support a relationship between Th17-cell homeostasis and B-cell maturation, with implications for the understanding of the pathogenesis of inflammatory/autoimmune diseases and the physiology of B-cell depleting therapies.

  2. Preclinical Evaluation of the Novel BTK Inhibitor Acalabrutinib in Canine Models of B-Cell Non-Hodgkin Lymphoma

    Science.gov (United States)

    Gardner, Heather L.; Izumi, Raquel; Hamdy, Ahmed; Rothbaum, Wayne; Coombes, Kevin R.; Covey, Todd; Kaptein, Allard; Gulrajani, Michael; Van Lith, Bart; Krejsa, Cecile; Coss, Christopher C.; Russell, Duncan S.; Zhang, Xiaoli; Urie, Bridget K.; London, Cheryl A.; Byrd, John C.; Johnson, Amy J.; Kisseberth, William C.

    2016-01-01

    Acalabrutinib (ACP-196) is a second-generation inhibitor of Bruton agammaglobulinemia tyrosine kinase (BTK) with increased target selectivity and potency compared to ibrutinib. In this study, we evaluated acalabrutinib in spontaneously occurring canine lymphoma, a model of B-cell malignancy similar to human diffuse large B-cell lymphoma (DLBCL). First, we demonstrated that acalabrutinib potently inhibited BTK activity and downstream effectors in CLBL1, a canine B-cell lymphoma cell line, and primary canine lymphoma cells. Acalabrutinib also inhibited proliferation in CLBL1 cells. Twenty dogs were enrolled in the clinical trial and treated with acalabrutinib at dosages of 2.5 to 20mg/kg every 12 or 24 hours. Acalabrutinib was generally well tolerated, with adverse events consisting primarily of grade 1 or 2 anorexia, weight loss, vomiting, diarrhea and lethargy. Overall response rate (ORR) was 25% (5/20) with a median progression free survival (PFS) of 22.5 days. Clinical benefit was observed in 30% (6/20) of dogs. These findings suggest that acalabrutinib is safe and exhibits activity in canine B-cell lymphoma patients and support the use of canine lymphoma as a relevant model for human non-Hodgkin lymphoma (NHL). PMID:27434128

  3. ADVERSE EFFECTS OF INTRAVENOUS IMMUNOGLOBULIN THERAPY IN PATIENTS WITH ANTIBODY DEFICIENCY

    Directory of Open Access Journals (Sweden)

    A. Aghamohammadi

    2003-09-01

    Full Text Available Long-term intravenous immunoglobulin (IVIG infusion is an effective treatment for children with humoral immunodeficiencies, already be complicated by systemic ad¬verse effects. In order to determine the adverse effects of intravenous immunoglobulin inpatients with antibody deficiency, 45 immunodeficientpatients receiving intravenous immunoglobulin were studied during a 36-month period at Children's Medical Center. The investigated group included 25 patients with common variable immunodeficiency, 14 patients with X-linked agammaglobulinemia and 6 patients with IgG subclass defi¬ciency. A total of fifty adverse effects occurred through 955 infusions (5.2%. The most frequent immediate adverse effects were mild (40 infusions out of 955 in 22 cases, including: chills, flushing, fever, nausea and headache. Three patients experienced mod¬erate effects (10 infusions out of 955 such as rash, severe headache, joint pain and chest tightness. None of the effects was anaphylactic type. It can be concluded that intravenous immunoglobulin is generally a well-tolerated medical agent for patients with antibody deficiency, but all patients should be monitored by a physician who is familiar with its indications, risks, adverse effects and their appropriate management.

  4. X连锁无丙种球蛋白血症的临床研究进展

    Institute of Scientific and Technical Information of China (English)

    孙金英; 刘乐宇

    2002-01-01

    @@ X连锁无丙种球蛋白血症(X-linked agammaglobulinemia,XLA),又称Bruton无丙种球蛋白血症,是最早发现的人类原发性免疫缺陷病(primary immunodeficiency disease,PID).1952年,Bruton[1]报道了1例在4年半内连续发生19次败血症的男孩,其中10次分离出肺炎双球菌.该患儿经血清蛋白电泳检查,结果未见丙种球蛋白电泳条带显示,予人丙种球蛋白注射治疗后,蛋白电泳图像上显现出丙种球蛋白的存在,并可持续6周左右.以后每月注射丙种球蛋白治疗,患儿在14个月内未再发生败血症.从此,人们开始认识了原发性免疫缺陷病.

  5. High Production of IL-18 by Dendritic Cells Induced by Sera from Patients with Primary Antibody Deficiency

    Directory of Open Access Journals (Sweden)

    Maryam Nourizadeh

    2007-06-01

    Full Text Available Predominantly antibody deficiencies are a category of primary immunodeficiency diseases, whichconsist of several rare disorders such as common variable immunodeficiency (CVID and X-linked agammaglobulinemia (XLA. We evaluated the effects of CVID and XLA patients’ sera as a source of microenviromental factors on maturation and function of monocyte-derived DCs.Blood was collected from 10 CVID and 5 XLA patients before immunoglobulin replacementtherapy and also from 8 healthy volunteers in order to obtain necessary sera for this study. Monocyte derived DCs were generated from blood cells obtained from healthy volunteers in the presence of GM-CSF, IL-4 and 10% serum concentrations from cases and controls. Immature DCs were incubated with monocyte conditioned medium (MCM and TNF-α in order to generate mature DCs. Interleukin 18 (IL-18 production by CD40L-activated mature DCs was measured after 24 hours of culture in vitro.IL-18 production by DCs generated in the presence of CVID and XLA patients’ sera were6.75±2.59 and 7.08±1.75 ng/ml, respectively, which were significantly higher than normal serumconditioned DCs (3.55±0.68 ng/ml.These results suggest that the sera of patients with predominantly antibody deficiencies maycontain soluble factor(s that can induce a significant increase in IL-18 production by DCs.

  6. Molecular genetic analysis of X-linked hypogammaglobulinemia and isolated growth hormone deficiency

    Energy Technology Data Exchange (ETDEWEB)

    Stewart, D.M.; Kurman, C.C.; Staudt, L.M. [Univ. of Brescia (Italy)] [and others

    1995-09-01

    In 1980 the clinical syndrome of X-linked hypogammaglobulinemia and isolated growth hormone deficiency (XLA/GHD) was described. XLA/GHD patients have reduced serum levels of Ig and normal cell-mediated immunity, and thus resemble patients with Bruton`s X-linked agammaglobulinemia (XLA). However, XLA/GHD patients also have isolated GHD. Mutations and deletions in the Bruton`s tyrosine kinase gene (BTK) are responsible for Bruton`s XLA. We investigated BTK gene expression in an XLA/GHD patient from the family originally described by Northern analysis, cDNA sequencing, and Western analysis of protein production using mAb to BTK. BTK mRNA was normal in size and abundance, and the mRNA sequence was normal over the coding region, except for a single silent mutation. BTK protein was present in normal amounts in PBMC of this patient. Thus, at the molecular level, XLA/GHD is a different disease entity from Bruton`s XLA. These results suggest that undescribed genes critical for B cell development and growth hormone production exist on the X chromosome. 17 refs., 4 figs.

  7. Human protein kinase C lota gene (PRKC1) is closely linked to the BTK gene in Xq21.3

    Energy Technology Data Exchange (ETDEWEB)

    Mazzarella, R.; Jones, C.; Schlessinger, D. [Washington Univ. School of Medicine, St. Louis, MO (United States)] [and others

    1995-04-10

    The human X chromosome contains many disease loci, but only a small number of X-linked genes have been cloned and characterized. One approach to finding genes in genomic DNA uses partial sequencing of random cDNAs to develop {open_quotes}expressed sequence tags{close_quotes} (ESTs). Many authors have recently reported chromosomal localization of such ESTs using hybrid panels. Twenty ESTs specific for the X chromosome have been localized to defined regions with somatic cell hybrids, and 12 of them have been physically linked to markers that detect polymorphisms. One of these ESTs, EST02087, was physically linked in a 650-kb contig to the GLA ({alpha}-galactosidase) gene involved in Fabry disease. A comparison of this contig with a 7.5-Mb YAC contig indicated that this gene is also within 250 kb of the src-like protein-tyrosine kinase BTK (X-linked agammaglobulinemia protein-tyrosine kinase) gene in Xq21.3. 14 refs., 1 fig.

  8. THE CLINICAL SPECTRUM OF RESPIRATORY DISEASES IN PATIENTS WITH PRIMARY ANTIBODY DEFICIENCY

    Directory of Open Access Journals (Sweden)

    A. Aghamohammadi

    2000-08-01

    Full Text Available Primary Humoral Immunodeficiencies (PHID are currently increasingly being recognized. Patients with PHID frequently show respiratory complications.The objectives of the study is to determine the clinical spectrum of respiratory diseases in patients with PHID."We extracted data from the clinical files of patients with PHID, diagnosed according to WHO criteria. We encountered 125 patients (84 males, with the diagnosis of primary antibody deficiency including common-variable immunodeficiency (64 pts, x-linked agammaglobulinemia (29 pts, IgA deficiency (20 pts, IgG-subc!ass deficiency (8 pts, and hyper-IgM syndrome (4 pts. The mean age of the patients at the time of study was 11 years. In the evolution of their disease, 92 cases (73.6% developed upper respiratory tract infections, among which acute otitis media (68 pts, 54.4%, sinusitis (61 pts, 48.8%, and pharyngitis (12 pts, 10.4% were found to be the most frequent. Among the lower respiratory tract infections, pneumonia was the most common occurance (91 pts, 72.8%. The other lower respiratory tract complications were: bronchiectasis (22 pts, 17.6%, bronchitis (8 pts, tuberculosis (6 pts, lung abscess (4 pts, and Pneumocystis carinii pneumonia (2 pts.Respiratory infections constitute the most common presenting symptom of patients with primary humoral immunodeficiency. There may be some differences in the type and frequency of infections in each of these disorders.

  9. Otological findings in pediatric patients with hypogammaglobulinemia.

    Directory of Open Access Journals (Sweden)

    Marzieh Tavakol

    2014-06-01

    Full Text Available The main clinical presentation of patients with primary antibody deficiency (PAD incorporates upper respiratory tract infections comprising otitis media, sinusitis and pneumonia. This study was designed to investigate clinical and paraclinical otological complications in major types of PAD. A cross sectional study was conducted on 55 PAD patients with diagnosis of selective IgA deficiency, common variable immunodeficiency (CVID, X-linked agammaglobulinemia (XLA, and hyper IgM syndrome. All patients underwent otological examinations, audiometry, and auditory brain stem response. Otological complications were detected in 54.5% of PAD patients. Conductive hearing loss was the main finding amongst PID patients (73.3% followed by sensorineural hearing loss which was present in 8 cases. Otitis media with effusion (21.8%, chronic otitis media (27.2%, tympanosclerosis with intact tympanic membrane (5.4% and auditory neuropathy (3.6% were most important found complications. CVID and XLA patients with prophylactic usage of antibiotics had lower rate of audiological complications (p=0.04 and otitis media with effusion (p=0.027. As our results showed, asymptomatic otological findings were not rare in PAD patients; therefore, a systematic otological investigation is recommended as an integral part of the management and follow-up of these patients.

  10. Vesicourethral reflux-induced renal failure in a patient with ICF syndrome due to a novel DNMT3B mutation.

    Science.gov (United States)

    Kutluğ, Seyhan; Ogur, Gönül; Yilmaz, Aysegül; Thijssen, Peter E; Abur, Ummet; Yildiran, Alisan

    2016-12-01

    ICF syndrome is a primary immunodeficiency disease characterized by hypo- or agammaglobulinemia, centromeric instability mainly on chromosomes 1, 9, and 16 and facial anomalies. ICF syndrome presents with frequent respiratory tract infections in infancy. A 20-month-old female patient was referred to our clinic due to frequent lower respiratory tract infections. ICF syndrome was considered because of comorbidity of hypogammaglobulinemia, facial anomalies, and neuromotor growth retardation. Metaphase chromosome analysis revealed centromeric instability on chromosomes 1, 9, and 16 and through Sanger a previously unreported homozygous missense mutation (c.1805T>C; [p.V602A]) was identified in the DNMT3B, confirming ICF1. The patient was found to have a breakdown in renal function 1 year later; the urinary system was examined and bilateral vesicoureteral reflux was found, warranting the need for dialysis in time. This report expands the mutation spectrum of ICF1 and is the first to describe bilateral vesicoureteral reflux accompanying ICF syndrome. © 2016 Wiley Periodicals, Inc.

  11. Functional interaction of caveolin-1 with Bruton's tyrosine kinase and Bmx.

    Science.gov (United States)

    Vargas, Leonardo; Nore, Beston F; Berglof, Anna; Heinonen, Juhana E; Mattsson, Pekka T; Smith, C I Edvard; Mohamed, Abdalla J

    2002-03-15

    Bruton's tyrosine kinase (Btk), a member of the Tec family of protein-tyrosine kinases, has been shown to be crucial for B cell development, differentiation, and signaling. Mutations in the Btk gene lead to X-linked agammaglobulinemia in humans and X-linked immunodeficiency in mice. Using a co-transfection approach, we present evidence here that Btk interacts physically with caveolin-1, a 22-kDa integral membrane protein, which is the principal structural and regulatory component of caveolae membranes. In addition, we found that native Bmx, another member of the Tec family kinases, is associated with endogenous caveolin-1 in primary human umbilical vein endothelial cells. Second, in transient transfection assays, expression of caveolin-1 leads to a substantial reduction in the in vivo tyrosine phosphorylation of both Btk and its constitutively active form, E41K. Furthermore, a caveolin-1 scaffolding peptide (amino acids 82--101) functionally suppressed the autokinase activity of purified recombinant Btk protein. Third, we demonstrate that mouse splenic B-lymphocytes express substantial amounts of caveolin-1. Interestingly, caveolin-1 was found to be constitutively phosphorylated on tyrosine 14 in these cells. The expression of caveolin-1 in B-lymphocytes and its interaction with Btk may have implications not only for B cell activation and signaling, but also for antigen presentation.

  12. Reconstitution of Btk signaling by the atypical tec family tyrosine kinases Bmx and Txk.

    Science.gov (United States)

    Tomlinson, M G; Kurosaki, T; Berson, A E; Fujii, G H; Johnston, J A; Bolen, J B

    1999-05-07

    Bruton's tyrosine kinase (Btk) is mutated in X-linked agammaglobulinemia patients and plays an essential role in B cell receptor signal transduction. Btk is a member of the Tec family of nonreceptor protein-tyrosine kinases that includes Bmx, Itk, Tec, and Txk. Cell lines deficient for Btk are impaired in phospholipase C-gamma2 (PLCgamma2)-dependent signaling. Itk and Tec have recently been shown to reconstitute PLCgamma2-dependent signaling in Btk-deficient human cells, but it is not known whether the atypical Tec family members, Bmx and Txk, can reconstitute function. Here we reconstitute Btk-deficient DT40 B cells with Bmx and Txk to compare their function with other Tec kinases. We show that in common with Itk and Tec, Bmx reconstituted PLCgamma2-dependent responses including calcium mobilization, extracellular signal-regulated kinase (ERK) mitogen-activated protein kinase (MAPK) activation, and apoptosis. Txk also restored PLCgamma2/calcium signaling but, unlike other Tec kinases, functioned in a phosphatidylinositol 3-kinase-independent manner and failed to reconstitute apoptosis. These results are consistent with a common role for Tec kinases as amplifiers of PLCgamma2-dependent signal transduction, but suggest that the pleckstrin homology domain of Tec kinases, absent in Txk, is essential for apoptosis.

  13. Basic and clinical immunology

    Science.gov (United States)

    Chinen, Javier; Shearer, William T.

    2003-01-01

    Progress in immunology continues to grow exponentially every year. New applications of this knowledge are being developed for a broad range of clinical conditions. Conversely, the study of primary and secondary immunodeficiencies is helping to elucidate the intricate mechanisms of the immune system. We have selected a few of the most significant contributions to the fields of basic and clinical immunology published between October 2001 and October 2002. Our choice of topics in basic immunology included the description of T-bet as a determinant factor for T(H)1 differentiation, the role of the activation-induced cytosine deaminase gene in B-cell development, the characterization of CD4(+)CD25(+) regulatory T cells, and the use of dynamic imaging to study MHC class II transport and T-cell and dendritic cell membrane interactions. Articles related to clinical immunology that were selected for review include the description of immunodeficiency caused by caspase 8 deficiency; a case series report on X-linked agammaglobulinemia; the mechanism of action, efficacy, and complications of intravenous immunoglobulin; mechanisms of autoimmunity diseases; and advances in HIV pathogenesis and vaccine development. We also reviewed two articles that explore the possible alterations of the immune system caused by spaceflights, a new field with increasing importance as human space expeditions become a reality in the 21st century.

  14. SAP expression in invariant NKT cells is required for cognate help to support B-cell responses.

    Science.gov (United States)

    Detre, Cynthia; Keszei, Marton; Garrido-Mesa, Natividad; Kis-Toth, Katalin; Castro, Wilson; Agyemang, Amma F; Veerapen, Natacha; Besra, Gurdyal S; Carroll, Michael C; Tsokos, George C; Wang, Ninghai; Leadbetter, Elizabeth A; Terhorst, Cox

    2012-07-05

    One of the manifestations of X-linked lymphoproliferative disease (XLP) is progressive agammaglobulinemia, caused by the absence of a functional signaling lymphocyte activation molecule (SLAM)-associated protein (SAP) in T, invariant natural killer T (NKT) cells and NK cells. Here we report that α-galactosylceramide (αGalCer) activated NKT cells positively regulate antibody responses to haptenated protein antigens at multiple checkpoints, including germinal center formation and affinity maturation. Whereas NKT cell-dependent B cell responses were absent in SAP(-/-).B6 mice that completely lack NKT cells, the small number of SAP-deficient NKT cells in SAP(-/-).BALB/c mice adjuvated antibody production, but not the germinal center reaction. To test the hypothesis that SAP-deficient NKT cells can facilitate humoral immunity, SAP was deleted after development in SAP(fl/fl).tgCreERT2.B6 mice. We find that NKT cell intrinsic expression of SAP is dispensable for noncognate helper functions, but is critical for providing cognate help to antigen-specific B cells. These results demonstrate that SLAM-family receptor-regulated cell-cell interactions are not limited to T-B cell conjugates. We conclude that in the absence of SAP, several routes of NKT cell-mediated antibody production are still accessible. The latter suggests that residual NKT cells in XLP patients might contribute to variations in dysgammaglobulinemia.

  15. Newborn Screening for Primary Immunodeficiencies: Focus on Severe Combined Immunodeficiency (SCID and Other Severe T-Cell Lymphopenias

    Directory of Open Access Journals (Sweden)

    Stephan Borte

    2015-12-01

    Full Text Available Primary immunodeficiencies (PID are congenital disorders of immune competence, which are mainly characterized by a pathological susceptibility to infection. More than 240 PID disease entities have been defined so far, accounting for a broad spectrum of clinical symptoms and severity. Severe PID are increasingly becoming appreciated as a relevant health problem, and diagnostic procedures and screening profiles to allow earliest possible diagnosis on a population scale have already been developed in the USA and few European countries. The most severe PID are characterized by significant mortality in the first years of life, as well as serious morbidity with irreversible organ damage. This applies in particular to PID that are defined by the absence or functional anergy of T-lymphocytes (severe combined immunodeficiency; SCID or B-lymphocytes (e.g., X-linked agammaglobulinemia; XLA. A strategy to improve the outcome of severe PID by prompt diagnosis and immediate adequate treatment is screening newborns for the presence of T and B cells.

  16. Close linkage of the locus for X chromosome-linked severe combined immunodeficiency to polymorphic DNA markers in Xq11-q13

    Energy Technology Data Exchange (ETDEWEB)

    de Saint Basile, G.; Arveiler, B.; Oberle, I.; Malcolm, S.; Levinsky, R.J.; Lau, Y.L.; Hofker, M.; Debre, M.; Fischer, A.; Griscelli, C.; Mandel, J.L.

    1987-11-01

    The gene for X chromosome-linked severe combined immunodeficiency (SCID), a disease characterized by a block in early T-cell differentiation, has been mapped to the region Xq11-q13 by linkage analysis with restriction fragment length polymorphisms. High logarithm of odds (lod) scores were obtained with the marker 19.2 (DXS3) and with the marker cpX73 (DXS159) that showed complete cosegregation with the disease locus in the informative families analyzed. Other significant linkages were obtained with several markers from Xq11 to q22. With the help of a recently developed genetic map of the region, it was possible to perform multipoint linkage analysis, and the most likely genetic order is DXS1-(SCID, DXS159)-DXYS1-DXYS12-DXS3, with a maximum multipoint logarithm of odds score of 11.0. The results demonstrate that the SCID locus (gene symbol IMD4) is not closely linked to the locus of Bruton's agammaglobulinemia (a defect in B-cell maturation). They also provide a way for a better estimation of risk for carrier and antenatal diagnosis.

  17. Compensatory signals associated with the activation of human GC 5' splice sites.

    Science.gov (United States)

    Kralovicova, Jana; Hwang, Gyulin; Asplund, A Charlotta; Churbanov, Alexander; Smith, C I Edvard; Vorechovsky, Igor

    2011-09-01

    GC 5' splice sites (5'ss) are present in ∼1% of human introns, but factors promoting their efficient selection are poorly understood. Here, we describe a case of X-linked agammaglobulinemia resulting from a GC 5'ss activated by a mutation in BTK intron 3. This GC 5'ss was intrinsically weak, yet it was selected in >90% primary transcripts in the presence of a strong and intact natural GT counterpart. We show that efficient selection of this GC 5'ss required a high density of GAA/CAA-containing splicing enhancers in the exonized segment and was promoted by SR proteins 9G8, Tra2β and SC35. The GC 5'ss was efficiently inhibited by splice-switching oligonucleotides targeting either the GC 5'ss itself or the enhancer. Comprehensive analysis of natural GC-AG introns and previously reported pathogenic GC 5'ss showed that their efficient activation was facilitated by higher densities of splicing enhancers and lower densities of silencers than their GT 5'ss equivalents. Removal of the GC-AG introns was promoted to a minor extent by the splice-site strength of adjacent exons and inhibited by flanking Alu repeats, with the first downstream Alus located on average at a longer distance from the GC 5'ss than other transposable elements. These results provide new insights into the splicing code that governs selection of noncanonical splice sites.

  18. Development of a Low-Cost Stem-Loop Real-Time Quantification PCR Technique for EBV miRNA Expression Analysis.

    Science.gov (United States)

    Bergallo, Massimiliano; Merlino, Chiara; Montin, Davide; Galliano, Ilaria; Gambarino, Stefano; Mareschi, Katia; Fagioli, Franca; Montanari, Paola; Martino, Silvana; Tovo, Pier-Angelo

    2016-09-01

    MicroRNAs (miRNAs) are short, single stranded, non-coding RNA molecules. They are produced by many different species and are key regulators of several physiological processes. miRNAs are also encoded by the genomes of multiple virus families, such as herpesvirus family. In particular, miRNAs from Epstein Barr virus were found at high concentrations in different associated pathologies, such as Burkitt's lymphoma, Hodgkin disease, and nasopharyngeal carcinoma. Thanks to their stability, these molecules could possibly serve as biomarkers for EBV-associated diseases. In this study, a stem-loop real-time PCR for miR-BART2-5p, miR-BART15, and miR-BART22 EBV miRNAs detection and quantification has been developed. Evaluation of these miRNAs in 31 serum samples (12 from patients affected by primary immunodeficiency, 9 from X-linked agammaglobulinemia and 10 from healthy subjects) has been carried out. The amplification performance showed a wide dynamic range (10(8)-10(2) copies/reaction) and sensibility equal to 10(2) copies/reaction for all the target tested. Serum samples analysis, on the other hand, showed a statistical significant higher level of miR-BART22 in primary immunodeficiency patients (P = 0.0001) compared to other groups and targets. The results confirmed the potential use of this assay as a tool for monitoring EBV-associated disease and for miRNAs expression profile analysis.

  19. A novel Tth111I restriction fragment length polymorphism (RFLP) allows tracing of X-chromosome inactivation in the (Xid) hetrozygote

    Energy Technology Data Exchange (ETDEWEB)

    Shanmugam, V.; Sell, W.; Saha, B.K. [Emory Univ. of School of Medicine, Atlanta, GA (United States)] [and others

    1996-02-01

    The X-linked immunodeficiency (Xid) in CBA/N mice serves as a model for the X-linked agammaglobulinemia (XLA) syndrome in man. X-chromosome inactivation in F{sub 1} heterozygotes derived from CBA/N (X{sup xid}/X{sup xid}) and B6.Pgk-1a (X{sup +}/Y) was investigated by monitoring the methylation status of the individual Pgk-1 alleles, Pgk-1b and Pgk-1a, respectively, using a novel Tth111I RFLP. Results indicate that in circulating B lymphocytes of female heterozygotes, only the X chromosomes carrying the normal alleles (X{sup +}) are active (nonrandom inactivation of the X chromosome), whereas in non-B cells both the X chromosomes (X{sup +} and X{sup xid}) are active (random inactivation of the X chromosome). These results were further confirmed by direct evaluation of transcription of the Btk gene, the gene mutated both in Xid and in XLA. 36 refs., 2 figs., 2 tabs.

  20. Construction of a YAC contig and STS map spanning 2.5 Mbp in Xq25, the critical region for the X-linked lymphoproliferative (XLP) gene

    Energy Technology Data Exchange (ETDEWEB)

    Lanyi, A.; Li, B.F.; Li, S. [Univ. of Nebraska Medical Center, Omaha, NE (United States)] [and others

    1994-09-01

    X-linked lymphoproliferative disease (XLP) is characterized by a marked vulnerability in Epstein-Barr virus (EBV) infection. Infection of XLP patients with EBV invariably results in fatal mononucleosis, agammaglobulinemia or B-cell lymphoma. The XLP gene lies within a 10 cM region in Xq25 between DXS42 and DXS10. Initial chromosome studies revealed an interstitial, cytogenetically visible deletion in Xq25 in one XLP family (43-004). We estimated the size of the Xq25 deletion by dual laser flow karyotyping to involve 2% of the X chromosome, or approximately 3 Mbp of DNA sequences. To further delineate the deletion we performed a series of pulsed field gel electrophoresis (PFGE) analyses which showed that DXS6 and DXS100, two Xq25-specific markers, are missing from 45-004 DNA. Five yeast artificial chromosomes (YACs) from a chromosome X specific YAC library containing sequences deleted in patient`s 43-004 DNA were isolated. These five YACs did not overlap, and their end fragments were used to screen the CEPH MegaYAC library. Seven YACs were isolated from the CEPH MegaYAC library. They could be arranged into a contig which spans between DXS6 and DXS100. The contig contains a minimum of 2.5 Mbp of human DNA. A total of 12 YAC end clone, lambda subclones and STS probes have been used to order clones within the contig. These reagents were also used in Southern blot and patients showed interstitial deletions in Xq25. The size of these deletions range between 0.5 and 2.5 Mbp. The shortest deletion probably represents the critical region for the XLP gene.

  1. Health-Related Quality of Life in Primary Immune Deficient Patients

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    "Habibeh Mozaffari

    2006-03-01

    Full Text Available The primary immunodeficiency (PI disorders are abnormalities in development and maturation of the immune system. Individuals with PI disease may experience frequent infections, which limit their abilities to exhibit physical and psychological well-being secondary to their illness. In this survey we compared health-related quality of life of primary immune deficient patients with healthy children. The case-control study was designed for patients with PI disease who were referred to Children Medical Center in 2004-2005. Demographic information was taken and Pediatric Quality Of Life (PEDQOL questionnaire were filled for 50 PI patients and 100 healthy children. The mean age in PI patients was 12.62± 3.65 (range from 8 to 18 years and in the control group was 11.04± 3.3 years. In PI patients 68% were male and 32% female .Most patients with PI disease had a diagnosis of common variable immunodeficiency (54% or X-linked agammaglobulinemia (24%. Patients with PI disease had great limitations in physical functioning and psychological well-being (p<0.001 and p<0.001 respectively compared with children without a chronic health condition. Patients had lower PEDQOL scores in all age groups compared with normal sample (p<0.001. Long duration of disease significantly correlated with low psychological score. (r = -3.23. P= 0.03 Children with PI disease experience poorer health related quality of life than healthy children, indicating more attention should be paid to early diagnosis and treatment of PI disease, as well as more attention to their social limitation. PI patients may need psychological consultation for better coping with their illness.

  2. Oral and Dental Health Status in Patients with Primary Antibody Deficiencies

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    Ghasem Meighani

    2011-12-01

    Full Text Available Primary antibody deficiencies (PAD are a group of immune system disorders, associated with decreased levels of secretory and protective immunoglobulins. Because of the important role of immunoglobulins in the protection  of oral cavity, patients with PADs  are more susceptible to dental caries or oral manifestations.This study was performed  to investigate the oral and dental manifestations of PADs patients. In this study, 33 patients with PADs (21 common variable immunodeficiency, 8 X- linked agammaglobulinemia and 4 hyper IgM syndrome and 66 controls were examined; the number of decayed, missed and filled teeth (DMFT were investigated.Aphthous  was the most frequent manifestation in PADs patients (38.7%, which wassignificantly16.7% higher than  the  controls  (p=0.03. The  patients  with  PADs  showed significantly higher presentation of other oral and dental manifestations, including herpes sores, candidiasis tonsillitis, gingivitis, calculus, enamel hypoplasia and other ulcerations. The mean DMFT scores were 6.15±3.6 and 1.93±0.4 in PADs patients and controls, respectively (p<0.001. Although the patients with common variable immunodeficiency had higher means of DMFT in comparison with other groups of PADs, this difference was not statistically significant.This study showed significantly higher frequency of oral and dental manifestations in the patients with PADs  compared to controls. Therefore, regular examination of oral cavity could be suggested in this group of immunodeficient patients.

  3. A conditional form of Bruton's tyrosine kinase is sufficient to activate multiple downstream signaling pathways via PLC Gamma 2 in B cells

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    Witte Owen N

    2001-06-01

    Full Text Available Abstract Background Bruton's tyrosine kinase (Btk is essential for B cell development and function. Mutations of Btk elicit X-linked agammaglobulinemia in humans and X-linked immunodeficiency in the mouse. Btk has been proposed to participate in B cell antigen receptor-induced signaling events leading to activation of phospholipase C-γ2 (PLCγ2 and calcium mobilization. However it is unclear whether Btk activation is alone sufficient for these signaling events, and whether Btk can activate additional pathways that do not involve PLCγ2. To address such issues we have generated Btk:ER, a conditionally active form of the kinase, and expressed it in the PLCγ2-deficient DT40 B cell line. Results Activation of Btk:ER was sufficient to induce multiple B cell signaling pathways in PLCγ2-sufficient DT40 cells. These included tyrosine phosphorylation of PLCγ2, mobilization of intracellular calcium, activation of extracellular signal-regulated kinase (ERK and c-Jun NH2-terminal kinase (JNK mitogen-activated protein kinase (MAPK pathways, and apoptosis. In DT40 B cells deficient for PLCγ2, Btk:ER activation failed to induce the signaling events described above with the consequence that the cells failed to undergo apoptosis. Conclusions These data suggest that Btk:ER regulates downstream signaling pathways primarily via PLCγ2 in B cells. While it is not known whether activated Btk:ER precisely mimics activated Btk, this conditional system will likely facilitate the dissection of the role of Btk and its family members in a variety of biological processes in many different cell types.

  4. Genomic organization of Bruton`s tyrosine kinase

    Energy Technology Data Exchange (ETDEWEB)

    Rohrer, J.; Conley, M.E. [Univ. of Tennessee, Memphis, TN (United States)

    1994-09-01

    Bruton`s tyrosine kinase (Btk), is a nonreceptor tyrosine kinase that has been identified as the defective gene in X-linked agammaglobulinemia (XLA). XLA patients have profound hypogammaglobulinemia and markedly reduced numbers of B cells while their T cell and phagocyte numbers remain normal. To determine the genomic organization of Btk, intron/exon borders were identified by sequencing cosmid DNA using cDNA primers. Nineteen exons spanning 37 kb of genomic DNA were identified. All the intron/exon splice junctions followed the GT/AG rule. The translational ATG start codon was in exon 2 which was 6 kb downstream of exon 1. Exon 19, 519 bp in length and 3.8 kb distal to exon 18, was the largest exon and included the 450 bp of the 3{prime} untranslated region. Exons 6 through 18 formed the largest cluster of exons with no intron being longer than 1550 bp. There was no apparent correlation between the exon boundaries of Btk and the functional domains of the protein or the exon boundaries of src, the nonreceptor protein tyrosine kinase prototype. The region 500 bp upstream of the presumed transcriptional start site was sequenced and found to have a G+C content of 52%. No TATA-type promoter elements in the -20 bp to -30 bp region were identified. However, at position -48 bp, a TGTGAA motif was found that bears some similarity to the TATA box. This sequence was preceded by a perfect inverted CCAAT box at position -90 bp. Three retinoic acid binding sites were also identified at positions -50 bp, -83 bp and -197 bp. Defining the genomic structure of Btk will permit us to identify regulatory elements in this gene and to identify mutations in genomic DNA of patients with XLA.

  5. Isolation of cosmid and cDNA clones in the region surrounding the BTK gene at Xq21.3-q22

    Energy Technology Data Exchange (ETDEWEB)

    Vorechovsky, I.; Zhou, J.N.; Hammarstroem, L. [Karolinska Institute, Huddinge (Sweden)] [and others

    1994-06-01

    A regional physical and transcription map involving yeast artificial chromosomes (YACs), cosmids, and cDNAs has been constructed for Xq21.3-q22 around the gene BTK (formerly atk or BPK) defective in X-linked agammaglobulinemia (XLA). With a positional cloning strategy employing direct cDNA selection, novel cDNAs were found to cluster in the region of approximately 100 kb flanking the XLA and {alpha}-galactosidase A loci. While these widely expressed transcripts are in the area known to contain CpG islands, a less evolutionarily conserved gene, located more than 130 kb distal of DXS178, maps to cosmid clones that could not be digested with rare-cutting restriction enzymes. The presence of transcribed sequences flanking the BTK allowed investigation of their involvement in complex XLA phenotypes. Southern blot analysis using cDNA clones isolated from this region permitted exclusion of a contiguous deletion syndrome as an underlying defect in three patients with XLA and associated growth hormone deficiency. A single XLA patient with torsion dystonia and cosegregating X-linked deafness has been found with a deletion in the 3{prime} part of BTK extending centromerically into the flanking expressed sequence DXS1274E. This suggests a possible involvement of the DXS1274E in this phenotype. The GenBank accession numbers for novel cDNA sequences are as follows: DXS1269E (L20773), DXS1271E (UO1923), DXS1273E (UO1925), and DXS1274E (UO1922). 51 refs., 4 figs., 1 tab.

  6. The Effect of IVIG on Superoxide Generation in Primary Humoral Immunodeficiencies

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    Gulay Sezgin

    2016-01-01

    Full Text Available Primary antibody deficiency (common variable immunodeficiency, Hyper IgM, X-linked agammaglobulinemia and selective Ig A deficiency is a group of heterogeneous diseases characterized by defective antibody production. In primary hypogammaglobulinemias, particularly in patients with common variable immunodeficiency there is an increased generation of reactive oxygen species from monocytes which may be important for both immunopathogenesis and clinical manifestations. The generation of toxic oxygen metabolites may contribute to inflammation and tissue damage associated with phagocytic infiltration, and play role in the pathogenesis of malignancies, autoimmune disorders, acute and chronic pulmonary diseases seen in these patients. In primary immunodeficiencies and functional antibody deficiencies, IVIG act as replacement therapy and several mechanisms of IVIG action have been postulated. In vitro studies with human granulocytes showed stimulation of respiratory burst and promotion of bacterial killing by IVIG. In adult patients with primary humoral immunodeficiency, treated with IVIG showed that IVIG does not affect superoxide generation. We investigated superoxide generation from PMNL in 35 children with hyper IgM syndrome, XLA, CVID and IgA deficiency and 13 healthy children. We also explored the effect of IVIG administration on superoxide generation from granulocytes, white cell count, absolute neutrophil count, absolute lymphocyte count and quantitative CRP levels. There was a substantial increase in superoxide generation from PMNL in patients with XLA, CVID and IgA deficiency. Comparison of the superoxide generation before, 24 hours and one week after IVIG treatment showed no difference. In patients with CVID, quantitative CRP levels before and 24 hours after IVIG revealed significant difference. Other parameters were not changed. It can be concluded that enhanced superoxide generation in patients with XLA, CVID, Ig A deficiency may result from

  7. A Tth111I RFLP in intron 1 of the mouse Pgk-1 gene allows tracing of X chromosome inactivation

    Energy Technology Data Exchange (ETDEWEB)

    Shanmugan, V.; Saha, B.K. [Emory Univ. School of Medicine, Atlanta, GA (United States)

    1994-09-01

    The X-linked immunodeficiency (xid) in CBA/N mice serves as a model for the X-linked agammaglobulinemia (XLA) syndrome in humans. Like the XLA carriers, the female mice heterozygous for xid (X{sup xid}/X{sup W}) are asymptomatic. The pattern of X chromosome inactivation in the F1 heterozygotes [CBA/N (X{sup xid}/X{sup xid}) X CAST/Ei (X{sup W}/Y)] was investigated by monitoring the methylation status of the two Pgk-1 alleles. Methylation of a CpG dinucleotide in the 5{prime} region of the Pgk-1 gene was previously shown to absolutely correlate with the inactivation of the corresponding X chromosome. In order to distinguish the two alleles, the proximal end of intron 1 of the Pgk-1 gene from CBA/N and CAST/Ei was sequenced. Several nucleotide polymorphisms, including a Tth111I RFLP, were detected in close proximity of the critical CpG dinucleotide. This allowed us to devise an assay based on PCR-amplification of a target DNA encompassing the CpG site as well as the Tth111I site. Results indicate that in circulating B lymphocytes of the female heterozygote only the X-chromosome carrying the normal allele is active (non-random inactivation of the X chromosome) whereas in non-B cells both the X chromosomes are active (random inactivation of the X chromosome). These results were further confirmed by direct measurement of transcription of the two alleles (X{sup xid} and X{sup W}).

  8. Btk29A-mediated tyrosine phosphorylation of armadillo/β-catenin promotes ring canal growth in Drosophila oogenesis.

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    Noriko Hamada-Kawaguchi

    Full Text Available Drosophila Btk29A is the ortholog of mammalian Btk, a Tec family nonreceptor tyrosine kinase whose deficit causes X-linked agammaglobulinemia in humans. The Btk29AficP mutation induces multiple abnormalities in oogenesis, including the growth arrest of ring canals, large intercellular bridges that allow the flow of cytoplasm carrying maternal products essential for embryonic development from the nurse cells to the oocyte during oogenesis. In this study, inactivation of Parcas, a negative regulator of Btk29A, was found to promote Btk29A accumulation on ring canals with a concomitant increase in the ring canal diameter, counteracting the Btk29AficP mutation. This mutation markedly reduced the accumulation of phosphotyrosine on ring canals and in the regions of cell-cell contact, where adhesion-supporting proteins such as DE-cadherin and β-catenin ortholog Armadillo (Arm are located. Our previous in vitro and in vivo analyses revealed that Btk29A directly phosphorylates Arm, leading to its release from DE-cadherin. In the present experiments, immunohistological analysis revealed that phosphorylation at tyrosine 150 (Y150 and Y667 of Arm was diminished in Btk29AficP mutant ring canals. Overexpression of an Arm mutant with unphosphorylatable Y150 inhibited ring canal growth. Thus Btk29A-induced Y150 phosphorylation is necessary for the normal growth of ring canals. We suggest that the dissociation of tyrosine-phosphorylated Arm from DE-cadherin allows dynamic actin to reorganize, leading to ring canal expansion and cell shape changes during the course of oogenesis.

  9. Dynamic Allostery Mediated by a Conserved Tryptophan in the Tec Family Kinases.

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    Nikita Chopra

    2016-03-01

    Full Text Available Bruton's tyrosine kinase (Btk is a Tec family non-receptor tyrosine kinase that plays a critical role in immune signaling and is associated with the immunological disorder X-linked agammaglobulinemia (XLA. Our previous findings showed that the Tec kinases are allosterically activated by the adjacent N-terminal linker. A single tryptophan residue in the N-terminal 17-residue linker mediates allosteric activation, and its mutation to alanine leads to the complete loss of activity. Guided by hydrogen/deuterium exchange mass spectrometry results, we have employed Molecular Dynamics simulations, Principal Component Analysis, Community Analysis and measures of node centrality to understand the details of how a single tryptophan mediates allostery in Btk. A specific tryptophan side chain rotamer promotes the functional dynamic allostery by inducing coordinated motions that spread across the kinase domain. Either a shift in the rotamer population, or a loss of the tryptophan side chain by mutation, drastically changes the coordinated motions and dynamically isolates catalytically important regions of the kinase domain. This work also identifies a new set of residues in the Btk kinase domain with high node centrality values indicating their importance in transmission of dynamics essential for kinase activation. Structurally, these node residues appear in both lobes of the kinase domain. In the N-lobe, high centrality residues wrap around the ATP binding pocket connecting previously described Catalytic-spine residues. In the C-lobe, two high centrality node residues connect the base of the R- and C-spines on the αF-helix. We suggest that the bridging residues that connect the catalytic and regulatory architecture within the kinase domain may be a crucial element in transmitting information about regulatory spine assembly to the catalytic machinery of the catalytic spine and active site.

  10. Recurrent pneumonia caused by genetic immunodeficiency: a prophylactic and rehabilitative approach

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    Renata Cristina de Angelo Calsaverini Leal

    2007-06-01

    Full Text Available Recurrent infections are a consequence of a series of genetic diseases characterized by deficiency in the immunological response. One of these diseases is the agammaglobulinemia, which is characterized by the basic defect in the maturation of lymphocytes B. The carrier of this kind of immunodeficiency, which is linked to the X (XLA chromosome, has had primary pneumonias that have evolved into secondary pneumonias (chronic lungs with sequelae after the third or fourth year of life. The clinical and rehabilitative quest for prophylaxis against the XLA immunodeficiency is accomplished in order to avoid the evolution of the bacterial infection into sequelae and loss of pulmonary function, which propitiates the recurrence of the disease and deteriorates the life quality of the patient. Forty cases of recurrent respiratory infections were studied. Some of them were associated with primary respiratory diseases without investigation of serum immunoglobulins and some were not. Casuistics was performed according to data from medical records with pertinent treatments collected from January 1997 to September 2004 at the Specialized Physiotherapy Center. Age average was 2.7 years of life. It is statistically impossible to precise results concerning only the immunosuppressed patients due to the lack of specific diagnosis. That is explained by the fact that recurrent XLA pneumonias may be attributed to the gastroesophageal reflux disease or to bronchial asthma. However, the improved results showed by the pulmonary function as preventive strategy were attributed to the respiratory physiotherapy, since intravenous immunoglobulin replacement therapies were not performed. Respiratory physiotherapy acts as a supportive factor in the healing process and occupies a fundamental role in the prophylaxis against recurrent respiratory clinical features, especially those of obstructive and secretionary characteristics.

  11. Dual phosphorylation of Btk by Akt/protein kinase b provides docking for 14-3-3ζ, regulates shuttling, and attenuates both tonic and induced signaling in B cells.

    Science.gov (United States)

    Mohammad, Dara K; Nore, Beston F; Hussain, Alamdar; Gustafsson, Manuela O; Mohamed, Abdalla J; Smith, C I Edvard

    2013-08-01

    Bruton's tyrosine kinase (Btk) is crucial for B-lymphocyte activation and development. Mutations in the Btk gene cause X-linked agammaglobulinemia (XLA) in humans and X-linked immunodeficiency (Xid) in mice. Using tandem mass spectrometry, 14-3-3ζ was identified as a new binding partner and negative regulator of Btk in both B-cell lines and primary B lymphocytes. The activated serine/threonine kinase Akt/protein kinase B (PKB) phosphorylated Btk on two sites prior to 14-3-3ζ binding. The interaction sites were mapped to phosphoserine pS51 in the pleckstrin homology domain and phosphothreonine pT495 in the kinase domain. The double-alanine, S51A/T495A, replacement mutant failed to bind 14-3-3ζ, while phosphomimetic aspartate substitutions, S51D/T495D, caused enhanced interaction. The phosphatidylinositol 3-kinase (PI3-kinase) inhibitor LY294002 abrogated S51/T495 phosphorylation and binding. A newly characterized 14-3-3 inhibitor, BV02, reduced binding, as did the Btk inhibitor PCI-32765 (ibrutinib). Interestingly, in the presence of BV02, phosphorylation of Btk, phospholipase Cγ2, and NF-κB increased strongly, suggesting that 14-3-3 also regulates B-cell receptor (BCR)-mediated tonic signaling. Furthermore, downregulation of 14-3-3ζ elevated nuclear translocation of Btk. The loss-of-function mutant S51A/T495A showed reduced tyrosine phosphorylation and ubiquitination. Conversely, the gain-of-function mutant S51D/T495D exhibited intense tyrosine phosphorylation, associated with Btk ubiquitination and degradation, likely contributing to the termination of BCR signaling. Collectively, this suggests that Btk could become an important new candidate for the general study of 14-3-3-mediated regulation.

  12. Antibody-Independent Function of Human B Cells Contributes to Antifungal T Cell Responses.

    Science.gov (United States)

    Li, Rui; Rezk, Ayman; Li, Hulun; Gommerman, Jennifer L; Prat, Alexandre; Bar-Or, Amit

    2017-03-08

    Fungal infections (e.g., Candida albicans) can manifest as serious medical illnesses, especially in the elderly and immune-compromised hosts. T cells are important for Candida control. Whether and how B cells are involved in antifungal immunity has been less clear. Although patients with agammaglobulinemia exhibit normal antifungal immunity, increased fungal infections are reported following B cell-depleting therapy, together pointing to Ab-independent roles of B cells in controlling such infections. To test how human B cells may contribute to fungal-associated human T cell responses, we developed a novel Ag-specific human T cell/B cell in vitro coculture system and found that human B cells could induce C. albicans-associated, MHC class II-restricted responses of naive T cells. Activated B cells significantly enhanced C. albicans-mediated Th1 and Th17 T cell responses, which were both strongly induced by CD80/CD86 costimulation. IL-6(+)GM-CSF(+) B cells were the major responding B cell subpopulation to C. albicans and provided efficient costimulatory signals to the T cells. In vivo B cell depletion in humans resulted in reduced C. albicans-associated T responses. Of note, the decreased Th17, but not Th1, responses could be reversed by soluble factors from B cells prior to depletion, in an IL-6-dependent manner. Taken together, our results implicate an Ab-independent cytokine-defined B cell role in human antifungal T cell responses. These findings may be particularly relevant given the prospects of chronic B cell depletion therapy use in lymphoma and autoimmune disease, as patients age and are exposed to serial combination therapies.

  13. Inmunodeficiencias humorales: Un estudio en tres Centros de Inmunología Clínica de adultos en la Ciudad de Buenos Aires

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    Diego S. Fernández Romero

    2011-08-01

    Full Text Available Las inmunodeficiencias humorales (IDH comprenden a un grupo de enfermedades caracterizadas por la imposibilidad de desarrollar una respuesta inmune efectiva mediada por anticuerpos. Estos pacientes presentan infecciones, principalmente por bacterias extracelulares capsuladas, del tracto respiratorio. El objetivo de nuestro estudio fue describir las características clínicas de una población de 128 pacientes derivados con sospecha o diagnóstico de IDH a tres centros para inmunodeficiencias de adultos, asistidos entre junio de 2004 y diciembre de 2009. Tres (2.3% consultaron por infecciones recurrentes en una sola oportunidad sin datos suficientes para su adecuada clasificación y fueron excluidos del estudio. De los 125 pacientes restantes, en 21 (16.8% se descartó IDH, en 8 (6.4% se diagnosticó inmunodeficiencia humoral secundaria (IDHS y en 96 (76.8% inmunodeficiencia humoral primaria (IDHP. Las causas de IDHS fueron: en un caso enfermedad renal, en uno uso de fenitoína, dos casos: gammapatía monoclonal y en 4 linfoma B. Las causas de las 96 IDHP fueron: 57 inmunodeficiencia común variable, 12 agammaglobulinemia ligada al cromosoma X, 10 deficiencia selectiva de IgA, 7 deficiencia de IgG1, 3 síndrome hiper-IgM, 3 deficiencia de IgM, 2 síndrome linfoproliferativo ligado al cromosoma X, un síndrome de Good y una deficiencia funcional de anticuerpos. Sesenta y siete pacientes estaban en seguimiento en el momento de la finalización del estudio, 25 de ellos estaban en seguimiento al iniciarse el estudio. De los 58 pacientes en seguimiento con indicación de tratamiento sustitutivo con gammaglobulina, 54 se encontraban en tratamiento al finalizar el estudio. En cuatro pacientes no se pudo confirmar el diagnóstico de IDHP.

  14. Primary immunodeficiency diseases in Latin America: the second report of the LAGID registry.

    Science.gov (United States)

    Leiva, Lily E; Zelazco, Marta; Oleastro, Matías; Carneiro-Sampaio, Magda; Condino-Neto, Antonio; Costa-Carvalho, Beatriz Tavares; Grumach, Anete Sevciovic; Quezada, Arnoldo; Patiño, Pablo; Franco, José Luis; Porras, Oscar; Rodríguez, Francisco Javier; Espinosa-Rosales, Francisco Javier; Espinosa-Padilla, Sara Elva; Almillategui, Diva; Martínez, Celia; Tafur, Juan Rodríguez; Valentín, Marilyn; Benarroch, Lorena; Barroso, Rosy; Sorensen, Ricardo U

    2007-01-01

    This is the second report on the continuing efforts of LAGID to increase the recognition and registration of patients with primary immunodeficiency diseases in 12 Latin American countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Honduras, Mexico, Panama, Paraguay, Peru, Uruguay, and Venezuela. This report reveals that from a total of 3321 patients registered, the most common form of primary immunodeficiency disease was predominantly antibody deficiency (53.2%) with IgA deficiency reported as the most frequent phenotype. This category was followed by 22.6% other well-defined ID syndromes, 9.5% combined T- and B-cell inmunodeficiency, 8.6% phagocytic disorders, 3.3% diseases of immune dysregulation, and 2.8% complement deficiencies. All countries that participated in the first publication in 1998 reported an increase in registered primary immunodeficiency cases, ranging between 10 and 80%. A comparison of the estimated minimal incidence of X-linked agammaglobulinemia, chronic granulomatous disease, and severe combined immunodeficiency between the first report and the present one shows an increase in the reporting of these diseases in all countries. In this report, the estimated minimal incidence of chronic granulomatous disease was between 0.72 and 1.26 cases per 100,000 births in Argentina, Chile, Costa Rica, and Uruguay and the incidence of severe combined immunodeficiency was 1.28 and 3.79 per 100,000 births in Chile and Costa Rica, respectively. However, these diseases are underreported in other participating countries. In addition to a better diagnosis of primary immunodeficiency diseases, more work on improving the registration of patients by each participating country and by countries that have not yet joined LAGID is still needed.

  15. Invasive Pneumococcal Disease in Children Can Reveal a Primary Immunodeficiency

    Science.gov (United States)

    Gaschignard, Jean; Levy, Corinne; Chrabieh, Maya; Boisson, Bertrand; Bost-Bru, Cécile; Dauger, Stéphane; Dubos, François; Durand, Philippe; Gaudelus, Joël; Gendrel, Dominique; Gras Le Guen, Christèle; Grimprel, Emmanuel; Guyon, Gaël; Jeudy, Catherine; Jeziorski, Eric; Leclerc, Francis; Léger, Pierre-Louis; Lesage, Fabrice; Lorrot, Mathie; Pellier, Isabelle; Pinquier, Didier; de Pontual, Loïc; Sachs, Philippe; Thomas, Caroline; Tissières, Pierre; Valla, Frédéric V.; Desprez, Philippe; Frémeaux-Bacchi, Véronique; Varon, Emmanuelle; Bossuyt, Xavier; Cohen, Robert; Abel, Laurent; Casanova, Jean-Laurent; Puel, Anne; Picard, Capucine

    2014-01-01

    Background. About 10% of pediatric patients with invasive pneumococcal disease (IPD) die from the disease. Some primary immunodeficiencies (PIDs) are known to confer predisposition to IPD. However, a systematic search for these PIDs has never been carried out in children presenting with IPD. Methods. We prospectively identified pediatric cases of IPD requiring hospitalization between 2005 and 2011 in 28 pediatric wards throughout France. IPD was defined as a positive pneumococcal culture, polymerase chain reaction result, and/or soluble antigen detection at a normally sterile site. The immunological assessment included abdominal ultrasound, whole-blood counts and smears, determinations of plasma immunoglobulin and complement levels, and the evaluation of proinflammatory cytokines. Results. We included 163 children with IPD (male-to-female ratio, 1.3; median age, 13 months). Seventeen children had recurrent IPD. Meningitis was the most frequent type of infection (87%); other infections included pleuropneumonitis, isolated bloodstream infection, osteomyelitis, endocarditis, and mastoiditis. One patient with recurrent meningitis had a congenital cerebrospinal fluid fistula. The results of immunological explorations were abnormal in 26 children (16%), and a PID was identified in 17 patients (10%), including 1 case of MyD88 deficiency, 3 of complement fraction C2 or C3 deficiencies, 1 of isolated congenital asplenia, and 2 of Bruton disease (X-linked agammaglobulinemia). The proportion of PIDs was much higher in children aged >2 years than in younger children (26% vs 3%; P 2 years, as PIDs may be discovered in up to 26% of cases. PMID:24759830

  16. Btk29A-mediated tyrosine phosphorylation of armadillo/β-catenin promotes ring canal growth in Drosophila oogenesis.

    Science.gov (United States)

    Hamada-Kawaguchi, Noriko; Nishida, Yasuyoshi; Yamamoto, Daisuke

    2015-01-01

    Drosophila Btk29A is the ortholog of mammalian Btk, a Tec family nonreceptor tyrosine kinase whose deficit causes X-linked agammaglobulinemia in humans. The Btk29AficP mutation induces multiple abnormalities in oogenesis, including the growth arrest of ring canals, large intercellular bridges that allow the flow of cytoplasm carrying maternal products essential for embryonic development from the nurse cells to the oocyte during oogenesis. In this study, inactivation of Parcas, a negative regulator of Btk29A, was found to promote Btk29A accumulation on ring canals with a concomitant increase in the ring canal diameter, counteracting the Btk29AficP mutation. This mutation markedly reduced the accumulation of phosphotyrosine on ring canals and in the regions of cell-cell contact, where adhesion-supporting proteins such as DE-cadherin and β-catenin ortholog Armadillo (Arm) are located. Our previous in vitro and in vivo analyses revealed that Btk29A directly phosphorylates Arm, leading to its release from DE-cadherin. In the present experiments, immunohistological analysis revealed that phosphorylation at tyrosine 150 (Y150) and Y667 of Arm was diminished in Btk29AficP mutant ring canals. Overexpression of an Arm mutant with unphosphorylatable Y150 inhibited ring canal growth. Thus Btk29A-induced Y150 phosphorylation is necessary for the normal growth of ring canals. We suggest that the dissociation of tyrosine-phosphorylated Arm from DE-cadherin allows dynamic actin to reorganize, leading to ring canal expansion and cell shape changes during the course of oogenesis.

  17. CD4 T cell immunity is critical for the control of simian varicella virus infection in a nonhuman primate model of VZV infection.

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    Kristen Haberthur

    2011-11-01

    Full Text Available Primary infection with varicella zoster virus (VZV results in varicella (more commonly known as chickenpox after which VZV establishes latency in sensory ganglia. VZV can reactivate to cause herpes zoster (shingles, a debilitating disease that affects one million individuals in the US alone annually. Current vaccines against varicella (Varivax and herpes zoster (Zostavax are not 100% efficacious. Specifically, studies have shown that 1 dose of varivax can lead to breakthrough varicella, albeit rarely, in children and a 2-dose regimen is now recommended. Similarly, although Zostavax results in a 50% reduction in HZ cases, a significant number of recipients remain at risk. To design more efficacious vaccines, we need a better understanding of the immune response to VZV. Clinical observations suggest that T cell immunity plays a more critical role in the protection against VZV primary infection and reactivation. However, no studies to date have directly tested this hypothesis due to the scarcity of animal models that recapitulate the immune response to VZV. We have recently shown that SVV infection of rhesus macaques models the hallmarks of primary VZV infection in children. In this study, we used this model to experimentally determine the role of CD4, CD8 and B cell responses in the resolution of primary SVV infection in unvaccinated animals. Data presented in this manuscript show that while CD20 depletion leads to a significant delay and decrease in the antibody response to SVV, loss of B cells does not alter the severity of varicella or the kinetics/magnitude of the T cell response. Loss of CD8 T cells resulted in slightly higher viral loads and prolonged viremia. In contrast, CD4 depletion led to higher viral loads, prolonged viremia and disseminated varicella. CD4 depleted animals also had delayed and reduced antibody and CD8 T cell responses. These results are similar to clinical observations that children with agammaglobulinemia have

  18. Optimization of immunoglobulin substitution therapy by a stochastic immune response model.

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    Marc Thilo Figge

    Full Text Available BACKGROUND: The immune system is a complex adaptive system of cells and molecules that are interwoven in a highly organized communication network. Primary immune deficiencies are disorders in which essential parts of the immune system are absent or do not function according to plan. X-linked agammaglobulinemia is a B-lymphocyte maturation disorder in which the production of immunoglobulin is prohibited by a genetic defect. Patients have to be put on life-long immunoglobulin substitution therapy in order to prevent recurrent and persistent opportunistic infections. METHODOLOGY: We formulate an immune response model in terms of stochastic differential equations and perform a systematic analysis of empirical therapy protocols that differ in the treatment frequency. The model accounts for the immunoglobulin reduction by natural degradation and by antigenic consumption, as well as for the periodic immunoglobulin replenishment that gives rise to an inhomogeneous distribution of immunoglobulin specificities in the shape space. Results are obtained from computer simulations and from analytical calculations within the framework of the Fokker-Planck formalism, which enables us to derive closed expressions for undetermined model parameters such as the infection clearance rate. CONCLUSIONS: We find that the critical value of the clearance rate, below which a chronic infection develops, is strongly dependent on the strength of fluctuations in the administered immunoglobulin dose per treatment and is an increasing function of the treatment frequency. The comparative analysis of therapy protocols with regard to the treatment frequency yields quantitative predictions of therapeutic relevance, where the choice of the optimal treatment frequency reveals a conflict of competing interests: In order to diminish immunomodulatory effects and to make good economic sense, therapeutic immunoglobulin levels should be kept close to physiological levels, implying high

  19. Differential evolutionary wiring of the tyrosine kinase Btk.

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    Hossain M Nawaz

    Full Text Available BACKGROUND: A central question within biology is how intracellular signaling pathways are maintained throughout evolution. Btk29A is considered to be the fly-homolog of the mammalian Bruton's tyrosine kinase (Btk, which is a non-receptor tyrosine-kinase of the Tec-family. In mammalian cells, there is a single transcript splice-form and the corresponding Btk-protein plays an important role for B-lymphocyte development with alterations within the human BTK gene causing the immunodeficiency disease X-linked agammaglobulinemia in man and a related disorder in mice. In contrast, the Drosophila Btk29A locus encodes two splice-variants, where the type 2-form is the more related to the mammalian Btk gene product displaying more than 80% homology. In Drosophila, Btk29A displays a dynamic pattern of expression through the embryonic to adult stages. Complete loss-of-function of both splice-forms is lethal, whereas selective absence of the type 2-form reduces the adult lifespan of the fly and causes developmental abnormalities in male genitalia. METHODOLOGY/PRINCIPAL FINDINGS: Out of 7004-7979 transcripts expressed in the four sample groups, 5587 (70-79% were found in all four tissues and strains. Here, we investigated the role of Btk29A type 2 on a transcriptomic level in larval CNS and adult heads. We used samples either selectively defective in Btk29A type 2 (Btk29A(ficP or revertant flies with restored Btk29A type 2-function (Btk29A(fic Exc1-16. The whole transcriptomic profile for the different sample groups revealed Gene Ontology patterns reflecting lifespan abnormalities in adult head neuronal tissue, but not in larvae. CONCLUSIONS: In the Btk29A type 2-deficient strains there was no significant overlap between transcriptomic alterations in adult heads and larvae neuronal tissue, respectively. Moreover, there was no significant overlap of the transcriptomic changes between flies and mammals, suggesting that the evolutionary conservation is confined

  20. 小儿X-连锁无丙种球蛋白血症误诊报告

    Institute of Scientific and Technical Information of China (English)

    林广; 刘改英; 王艳芳; 梁美玉

    2012-01-01

    目的 探讨X-连锁无丙种球蛋白血症(X-linked agammaglobulinemia,XLA)的诊治要点,以减少误诊误治.方法 对我院收治并误诊的XLA 1例的临床资料进行回顾性分析.结果 本例因反复发热伴咳嗽10余天入院.按支气管肺炎予抗感染治疗,发热、咳嗽症状控制不理想.患儿3岁前身体健康,以后每年患肺炎2次以上.后多次痰培养未发现细菌或L型细菌、真菌生长,多次查血免疫球蛋白G、A、M均测不出(过低).予丙种球蛋白静脉滴注,体温逐渐恢复正常,咳嗽渐好转.后检测患儿BTK基因18号内含子突变(C.1908+ 1G>C),而患者母亲同一个位点C.1908+ 1G未见异常.分析患儿基因突变可能为新发突变,从而明确诊断为XLA.患儿每月静脉滴注丙种球蛋白400 mg/kg,随访4个月未出现感染性疾病.结论 XLA临床表现无特异性,初期反复出现感染往往不注意,导致误诊.本病诊断多依赖临床和血丙种球蛋白测定结果,确诊的金标准为基因诊断.

  1. Solution structure of the human BTK SH3 domain complexed with a proline-rich peptide from p120cbl

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    Tzeng, S.-R.; Lou, Y.-C.; Pai, M.-T.; Jain, Moti L.; Cheng, J.-W. [National Tsing Hua University, Division of Structural Biology and Biomedical Science, Department of Life Science (China)

    2000-04-15

    X-linked agammaglobulinemia (XLA), an inherited disease, is caused by mutations in the Bruton's tyrosine kinase (BTK). The absence of functional BTK leads to failure of B cell differentiation which incapacitates antibody production in XLA patients leading to, sometimes lethal, bacterial infections. Point mutation in the BTK gene that leads to deletion of C-terminal 14 aa residues of BTK SH3 domain was found in one patient family. To understand the role of BTK in B cell development, we have determined the solution structure of BTK SH3 domain complexed with a proline-rich peptide from the protein product of c-cbl protooncogene (p120{sup cbl}). Like other SH3 domains, BTK SH3 domain consists of five {beta}-strands packed in two {beta}-sheets forming a {beta}-barrel-like structure. The rmsd calculated from the averaged coordinates for the BTK SH3 domain residues 218-271 and the p120{sup cbl} peptide residues 6-12 of the complex was 0.87 A ({+-}0.16 A) for the backbone heavy atoms (N, C, and C{sub {alpha}}) and 1.64 A ({+-}0.16 A) for all heavy atoms. Based on chemical shift changes and inter-molecular NOEs, we have found that the residues located in the RT loop, n-Src loop and helix-like loop between {beta}4 and {beta}5 of BTK SH3 domain are involved in ligand binding. We have also determined that the proline-rich peptide from p120{sup cbl} binds to BTK SH3 domain in a class I orientation. These results correlate well with our earlier observation that the truncated BTK SH3 domain (deletion of {beta}4, {beta}5 and the helix-like loop) exhibits weaker affinity for the p120{sup cbl} peptide. It is likely that the truncated SH3 domain fails to present to the ligand the crucial residues in the correct context and hence the weaker binding. These results delineate the importance of the C-terminus in the binding of SH3 domains and also indicate that improper folding and the altered binding behavior of mutant BTK SH3 domain likely lead to XLA.

  2. WHI-131 Promotes Osteoblast Differentiation and Prevents Osteoclast Formation and Resorption in Mice.

    Science.gov (United States)

    Cheon, Yoon-Hee; Kim, Ju-Young; Baek, Jong Min; Ahn, Sung-Jun; Jun, Hong Young; Erkhembaatar, Munkhsoyol; Kim, Min Seuk; Lee, Myeung Su; Oh, Jaemin

    2016-02-01

    The small molecule WHI-131 is a potent therapeutic agent with anti-inflammatory, antiallergic, and antileukemic potential. However, the regulatory effects of WHI-131 on osteoblast and osteoclast activity are unclear. We examined the effects of WHI-131 on osteoblast and osteoclast differentiation with respect to bone remodeling. The production of receptor activator of nuclear factor kappa-B ligand (RANKL) by osteoblasts in response to interleukin (IL)-1 or IL-6 stimulation decreased by 56.8% or 50.58%, respectively, in the presence of WHI-131. WHI-131 also abrogated the formation of mature osteoclasts induced by IL-1 or IL-6 stimulation. Moreover, WHI-131 treatment decreased RANKL-induced osteoclast differentiation of bone marrow-derived macrophages, and reduced the resorbing activity of mature osteoclasts. WHI-131 further decreased the mRNA and protein expression levels of c-Fos and nuclear factor of activated T cells, cytoplasmic 1 (NFATc1) by almost twofold, and significantly downregulated the mRNA expression of the following genes: tartrate-resistant acid phosphatase (TRAP), osteoclast-associated receptor (OSCAR), DC-STAMP, OC-STAMP, ATP6v0d2, and cathepsin K (CtsK) compared with the control group. WHI-131 further suppressed the phosphorylation of protein kinase B (Akt) and degradation of inhibitor of kappa B (IκB); Ca(2+) oscillation was also affected, and phosphorylation of the C-terminal Src kinase (c-Src)-Bruton agammaglobulinemia tyrosine kinase (Btk)-phospholipase C gamma 2 (PLCγ2) (c-Src-Btk-PLCg2 calcium signaling pathway) was inhibited following WHI-131 treatment. The Janus kinase-signal transducer and activator of transcription (JAK-STAT) signaling pathway was activated by WHI-131, accompanied by phosphorylation of STAT3 Ser727 and dephosphorylation of STAT6. In osteoblasts, WHI-131 caused an approximately fourfold increase in alkaline phosphatase activity and Alizarin Red staining intensity. Treatment with WHI-131 increased the mRNA expression

  3. Inmunodeficiencias humorales: Un estudio en tres Centros de Inmunología Clínica de adultos en la Ciudad de Buenos Aires Antibody deficiencies: A survey from three Clinical Immunology Centers for adults in Buenos Aires City

    Directory of Open Access Journals (Sweden)

    Diego S. Fernández Romero

    2011-08-01

    Full Text Available Las inmunodeficiencias humorales (IDH comprenden a un grupo de enfermedades caracterizadas por la imposibilidad de desarrollar una respuesta inmune efectiva mediada por anticuerpos. Estos pacientes presentan infecciones, principalmente por bacterias extracelulares capsuladas, del tracto respiratorio. El objetivo de nuestro estudio fue describir las características clínicas de una población de 128 pacientes derivados con sospecha o diagnóstico de IDH a tres centros para inmunodeficiencias de adultos, asistidos entre junio de 2004 y diciembre de 2009. Tres (2.3% consultaron por infecciones recurrentes en una sola oportunidad sin datos suficientes para su adecuada clasificación y fueron excluidos del estudio. De los 125 pacientes restantes, en 21 (16.8% se descartó IDH, en 8 (6.4% se diagnosticó inmunodeficiencia humoral secundaria (IDHS y en 96 (76.8% inmunodeficiencia humoral primaria (IDHP. Las causas de IDHS fueron: en un caso enfermedad renal, en uno uso de fenitoína, dos casos: gammapatía monoclonal y en 4 linfoma B. Las causas de las 96 IDHP fueron: 57 inmunodeficiencia común variable, 12 agammaglobulinemia ligada al cromosoma X, 10 deficiencia selectiva de IgA, 7 deficiencia de IgG1, 3 síndrome hiper-IgM, 3 deficiencia de IgM, 2 síndrome linfoproliferativo ligado al cromosoma X, un síndrome de Good y una deficiencia funcional de anticuerpos. Sesenta y siete pacientes estaban en seguimiento en el momento de la finalización del estudio, 25 de ellos estaban en seguimiento al iniciarse el estudio. De los 58 pacientes en seguimiento con indicación de tratamiento sustitutivo con gammaglobulina, 54 se encontraban en tratamiento al finalizar el estudio. En cuatro pacientes no se pudo confirmar el diagnóstico de IDHP.Antibody deficiency (AD comprises a group of diseases characterized by the inability to develop an effective antibody mediated immune response. These patients suffer mainly of encapsulated extracellular bacterial

  4. Primary hypogammaglobulinemia complicated with liver cirrhosis and literature review%抗体缺陷病并发肝硬化一例并文献复习

    Institute of Scientific and Technical Information of China (English)

    邓朝晖; 蒋丽蓉; 张斌; 徐亚珍; 沈丛欢; 周韬; 夏强; 张天遨

    2016-01-01

    目的 总结抗体缺陷病并发肝硬化患儿的病因、治疗及预后.方法 回顾性分析上海儿童医学中心收治的1例X连锁无丙种球蛋白血症并发肝硬化患儿的临床资料.应用维普及万方数据库,以“抗体缺陷病”“肝硬化”作为关键词对2015年1月以前15年文献进行检索;应用Pubmed医学检索,以“primary hypogammaglobulinaemia”“liver cirrhosis"为关键词,检索由1988年1月1日至2015年1月1日的文献,对文献病例资料进行总结.结果 患儿男,12岁,因“确诊X连锁无丙种球蛋白血症7年,吐血3次”于2014年12月入院.患儿有静脉输注丙种球蛋白6年病史,无丙型肝炎(丙肝)病毒感染,自身抗体阴性,乙型肝炎(乙肝)病毒表面抗体、e抗体及核心抗体阳性.胃镜示食管胃底静脉曲张,肝脏病理示肝细胞变性,坏死,纤维组织增生,假小叶形成.入院后接受肝移植,术后口服他克莫司3 mg/d,甲泼尼松5 mg/d,拉米夫定150 mg/d及阿昔洛韦900 mg/d,随访3个月,患儿病情稳定,肝功能正常.符合条件的中文文献0篇,英文文献13篇,共计19例患者,其中12例普通变异型免疫缺陷病,3例X连锁无丙种球蛋白血症,2例高IgM血症,2例先天性低丙种球蛋白血症.17例丙肝病毒感染,2例自身免疫性肝炎.17例丙肝病毒感染者中有15例静脉输注丙种球蛋白.19例病例中,7例存活.肝移植治疗5例,死亡3例.结论 除了传统认识的丙肝病毒感染及自身免疫性两大因素是抗体缺陷病并发肝硬化病因以外,乙肝病毒感染也是病因之一.静脉输注丙种球蛋白可能是传播丙肝及乙肝病毒感染的重要途径.抗体缺陷病并发肝硬化预后差,病死率高.%Objective To explore the pathogenesis,treatment and prognosis of primary hypogammaglobulinemia complicated with liver cirrhosis in a child.Method Pathogenesis,treatment and prognosis of X-linked agammaglobulinemia (XLA) complicated with liver cirrhosis in a

  5. Clinical features of invasive pneumococcus with resistance to antimicrobial agents in Pediatric Intensive Care Unit%儿童重症监护室中侵袭性肺炎链球菌病的临床特点及耐药性分析

    Institute of Scientific and Technical Information of China (English)

    刘珺; 王荃; 曾健生; 李峥; 钱素云

    2012-01-01

    Objective To study the clinical features of invasive pneumococcus disease (IPD) with resistance to antimicrobial agents in children,and to improve the diagnosis and treatment of this disease.Methods The clinical data from 21 IPD patients younger than 13 years old were collected from January 2008 through December 2010 in Pediatric Intensive Care Unit in Beijing Children's Hospital for retrospective analysis. Specimens of blood,pleural effusion,cerebrospinal fluid and soft tissue aspirated were collected from these children,and 23 strains of streptococcus pneumonia (SP) were cultured,isolated and confirmed,and the antibiotics susceptibility to penicillin and other antibiotics of these strains were assayed.Results Among the 21 IPD children,the ratio of male to female was 0.9∶1,and the age was 5 months to 13 years,with 61.9% of them under 2 years.Of them,12 patients (57.1% ) had purulent pleurisy,and 1 (4.8% )patient had an underlying disease diagnosed to be X - linked agammaglobulinemia (XLA).There was no seasonal difference in the occurrence rate of this disease. Eight (38.1%) patients were cured,11(52.4% ) were improved,while 2 (9.5% ) patients not improved without death.There was no statistically significant difference in the annual detection rate of invasive SP (x2 =3.711,P =0.156).The incidences of penicillin-intermediate susceptibility SP (PISP) and penicillin-resistant SP (PRSP) were 47.8% and 26.1% respectively.The rate of resistance to multiple antibiotics was 91.3%.Conclusions Children aged less than 5 years,especially younger than 2 years,are prone to IPD,and purulent pleurisy and septicemia are often seen in this disease. Some patients had the underlying diseases.The complications included hemophagocytic syndrome,acute respiratory distress syndrome,septic shock,bronchial pleural fistula and so on.The multidrug resistance rate was 91.3%.It is important to put great emphasis on the monitoring antibiotics resistance to invasive

  6. [Discriminant analysis to predict the clinical diagnosis of primary immunodeficiencies: a preliminary report].

    Science.gov (United States)

    Murata, Chiharu; Ramírez, Ana Belén; Ramírez, Guadalupe; Cruz, Alonso; Morales, José Luis; Lugo-Reyes, Saul Oswaldo

    2015-01-01

    cuatro enfermedades más prevalentes (agammaglobulinemia ligada al cromosoma X, enfermedad granulomatosa crónica, inmunodeficiencia común variable y ataxia-telangiectasia). Prácticamente en todos los casos el desempeño de la máquina fue superior al del experto humano en lo que respecta a la selección de los atributos más pertinentes para incorporar en los modelos. La predicción del diagnóstico con base en las ecuaciones construidas tuvo exactitud global de 83 a 94%, con sensibilidad de 60 a 100%, especificidad de 83 a 95% y coeficiente kappa de 0.37 a 0.76. Conclusiones: la selección de variables, en general, tiene plausibilidad clínica y tiene la ventaja práctica de utilizar solamente atributos clínicos, gérmenes encontrados y estudios de laboratorio de rutina (biometría hemática e inmunoglobulinas séricas). El desempeño del modelo como herramienta de predicción fue aceptable. Las principales limitaciones del estudio incluyen un tamaño de muestra limitado, lo que no permitió que realizáramos validación cruzada en la evaluación. Éste es solamente un primer paso en la construcción de un sistema de aprendizaje automático, con un abordaje más amplio que incluya una base de datos más grande y diferentes metodologías, para asistir el diagnóstico clínico de las inmunodeficiencias primarias.