染色体 11q 缺失患者的特征为同时累及 B 淋巴细胞和 T 淋巴细胞的先天性免疫缺陷。
Patients with Chromosome 11q Deletions Are Characterized by Inborn Errors of Immunity Involving both B and T Lymphocytes.
机构信息
Department of Pediatric Hematology, Erasmus Medical Center Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, the Netherlands.
Unit of Transfusion Medicine, Sanquin Blood Supply, Amsterdam, the Netherlands.
出版信息
J Clin Immunol. 2022 Oct;42(7):1521-1534. doi: 10.1007/s10875-022-01303-8. Epub 2022 Jun 28.
Disorders of the long arm of chromosome 11 (11q) are rare and involve various chromosomal regions. Patients with 11q disorders, including Jacobsen syndrome, often present with a susceptibility for bacterial and prolonged viral and fungal infections partially explained by hypogammaglobulinemia. Additional T lymphocyte or granular neutrophil dysfunction may also be present. In order to evaluate infectious burden and immunological function in patients with 11q disorders, we studied a cohort of 14 patients with 11q deletions and duplications. Clinically, 12 patients exhibited prolonged and repetitive respiratory tract infections, frequently requiring (prophylactic) antibiotic treatment (n = 7), ear-tube placement (n = 9), or use of inhalers (n = 5). Complicated varicella infections (n = 5), chronic eczema (n = 6), warts (n = 2), and chronic fungal infections (n = 4) were reported. Six patients were on immunoglobulin replacement therapy. We observed a high prevalence of low B lymphocyte counts (n = 8), decreased T lymphocyte counts (n = 5) and abnormal T lymphocyte function (n = 12). Granulocyte function was abnormal in 29% without a clinical phenotype. Immunodeficiency was found in patients with terminal and interstitial 11q deletions and in one patient with terminal 11q duplication. Genetically, FLI1 and ETS1 are seen as causative for the immunodeficiency, but these genes were deleted nor duplicated in 4 of our 14 patients. Alternative candidate genes on 11q may have a role in immune dysregulation. In conclusion, we present evidence that inborn errors of immunity are present in patients with 11q disorders leading to clinically relevant infections. Therefore, broad immunological screening and necessary treatment is of importance in this patient group.
11 号染色体长臂(11q)疾病较为罕见,涉及多个染色体区域。患有 11q 疾病的患者,包括 Jacobsen 综合征,通常易发生细菌感染,且病毒和真菌感染持续时间较长,部分原因是低丙种球蛋白血症。此外,T 淋巴细胞或颗粒性中性粒细胞功能障碍也可能存在。为了评估 11q 疾病患者的感染负担和免疫功能,我们研究了 14 例 11q 缺失和重复的患者队列。临床上,12 例患者表现为呼吸道感染持续时间长且反复发作,经常需要(预防性)抗生素治疗(n=7)、置管(n=9)或使用吸入器(n=5)。复杂的水痘感染(n=5)、慢性湿疹(n=6)、疣(n=2)和慢性真菌感染(n=4)也有报道。6 例患者接受免疫球蛋白替代治疗。我们观察到低 B 淋巴细胞计数(n=8)、T 淋巴细胞计数减少(n=5)和 T 淋巴细胞功能异常(n=12)的高发率。29%的患者中性粒细胞功能异常,但无临床表型。在末端和间质 11q 缺失的患者和 1 例末端 11q 重复的患者中发现免疫缺陷。FLI1 和 ETS1 基因突变被认为是导致免疫缺陷的原因,但我们的 14 例患者中有 4 例既未缺失也未重复这些基因。11q 上的其他候选基因可能在免疫失调中起作用。总之,我们的研究结果表明,11q 疾病患者存在先天性免疫缺陷,导致临床相关感染。因此,在该患者群体中,广泛的免疫筛查和必要的治疗非常重要。
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