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WHIM 综合征患者 WHIM-09 经 Chromothripsis 治疗后持续性中性粒细胞增多的机制。

Mechanisms of Sustained Neutrophilia in Patient WHIM-09, Cured of WHIM Syndrome by Chromothripsis.

机构信息

Laboratory of Molecular Immunology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bldg 10, Room 11N113, NIH, Bethesda, MD, 20892, USA.

出版信息

J Clin Immunol. 2018 Jan;38(1):77-87. doi: 10.1007/s10875-017-0457-8. Epub 2017 Nov 24.

Abstract

WHIM-09 is the first patient described with WHIM syndrome, an autosomal dominant form of neutropenia related to bone marrow retention of neutrophils. Originally diagnosed incorrectly with autoimmune neutropenia, the patient underwent splenectomy at age 9, but the absolute neutrophil count (ANC) did not rise. Subsequently, she was spontaneously cured by chromothripsis (chromosome shattering), which deleted the disease allele CXCR4 , and 163 other genes, on chromosome 2 in a single hematopoietic stem cell (HSC). Chromothriptic CXCR4 HSCs replaced CXCR4 WHIM HSCs, and the ANC rose to a new sustained and benign baseline ~ 2-3-fold above normal that had remained unexplained. Here, we show that splenectomized Cxcr4 mice had sustained and benign neutrophilia, phenocopying neutrophilia in WHIM-09. In addition, WHIM-09's granulocyte-macrophage precursor cells possessed increased granulocyte colony-forming activity ex vivo. Thus, WHIM-09's neutrophilia may be multifactorial, involving neutrophil-extrinsic factors (splenectomy), as well as CXCR4 haploinsufficiency-dependent neutrophil-intrinsic factors (increased myeloid precursor cell differentiation). The strong bone marrow retention signal for neutrophils conferred by the WHIM mutation may have prevented neutrophilia after splenectomy until the mutation was deleted by chromothripsis.

摘要

WHIM-09 是首例 WHIM 综合征患者,该病为常染色体显性遗传中性粒细胞减少症,与骨髓中中性粒细胞滞留有关。最初被误诊为自身免疫性中性粒细胞减少症,该患者在 9 岁时接受了脾切除术,但绝对中性粒细胞计数(ANC)并未升高。随后,她被染色体碎裂(染色体破碎)自发治愈,该过程在单个造血干细胞(HSC)中删除了疾病等位基因 CXCR4 和 163 个其他基因,位于 2 号染色体上。发生染色体碎裂的 CXCR4 HSCs 取代了 CXCR4 WHIM HSCs,ANC 上升至新的持续良性基线,比正常水平高出约 2-3 倍,原因尚不清楚。在这里,我们发现脾切除的 Cxcr4 小鼠存在持续良性的中性粒细胞增多症,与 WHIM-09 中的中性粒细胞增多症表型相同。此外,WHIM-09 的粒细胞-巨噬细胞前体细胞具有体外增加的粒细胞集落形成活性。因此,WHIM-09 的中性粒细胞增多症可能是多因素的,涉及中性粒细胞外在因素(脾切除术),以及 CXCR4 杂合不足依赖性中性粒细胞内在因素(骨髓前体细胞分化增加)。WHIM 突变赋予中性粒细胞的强烈骨髓滞留信号可能阻止了脾切除后的中性粒细胞增多症,直到该突变被染色体碎裂删除。

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