| 1. |
- Borte, Stephan, et al.
(författare)
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Neonatal screening for severe primary immunodeficiency diseases using high-throughput triplex real-time PCR.
- 2012
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Ingår i: Blood. - : American Society of Hematology. - 1528-0020 .- 0006-4971. ; 119:11, s. 2552-2555
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Tidskriftsartikel (refereegranskat)abstract
- Severe combined immunodeficiency (SCID) and X-linked agammaglobulinemia (XLA) are inborn errors of immune function that require prompt diagnosis and treatment to prevent life-threatening infections. The lack of functional T- or B-lymphocytes in these diseases serves as a diagnostic criterion and can be applied to neonatal screening. A robust triplex PCR method for quantitation of T cell receptor- (TREC) and kappa-deleting recombination excision circles (KREC), using a single Guthrie card punch, was developed and validated in a cohort of 2.560 anonymized newborn screening cards and in 50 original stored Guthrie cards from patients diagnosed with SCID, XLA, Ataxia-telangiectasia (AT), Nijmegen-breakage-syndrome (NBS), Common variable immunodeficiency (CVID), Immunoglobulin-A-deficiency (IgAD), or X-linked Hyper-IgM-syndrome (X-HIGM). Simultaneous measurement of TREC and KREC copy numbers in Guthrie card samples readily identified patients with SCID, XLA, AT and NBS and thus facilitates effective newborn screening for severe immunodeficiency syndromes characterized by the absence of T or B cells.
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| 2. |
- Borte, Stephan, et al.
(författare)
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Newborn screening for primary immunodeficiencies: beyond SCID and XLA.
- 2011
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Ingår i: Annals of the New York Academy of Sciences. - : Wiley. - 1749-6632 .- 0077-8923. ; 1246, s. 118-30
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Tidskriftsartikel (refereegranskat)abstract
- Primary immunodeficiencies (PID) encompass more than 250 disease entities, including phagocytic disorders, complement deficiencies, T cell defects, and antibody deficiencies. While differing in clinical severity, early diagnosis and treatment is of considerable importance for all forms of PID to prevent organ damage and life-threatening infections. During the past few years, neonatal screening assays have been developed to detect diseases hallmarked by the absence of T or B lymphocytes, classically seen in severe combined immunodeficiencies (SCID) and X-linked agammaglobulinemia (XLA). As described in this review, a reduction or lack of T and B cells in newborns is also frequently found in several other forms of PID, requiring supplemental investigation and involving the development of additional technical platforms in order to help classify abnormal screening results.
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| 3. |
- Borte, Stephan
(författare)
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Newborn screening for severe primary immunodeficiencies
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Primary immunodeficiencies (PID) are congenital disorders of immune competence, which are mainly characterized by a pathological susceptibility to infection. This is often accompanied by severe recurrent infections with drug-resistant, long progressions. In addition, there are associated immune regulation disorders, which may manifest themselves in granuloma formation, autoimmunity, recurrent fever, eczema, lymphoproliferation and chronic intestinal inflammation. More than 240 disease entities have been defined so far as PID, and just as extensive is the spectrum of clinical severity. While the most common congenital immunodeficiencies, such as selective IgA deficiency or C2 complement deficiency, have a mild phenotype which often remains undetected, severe PID are characterized by significant mortality in the first years of life, as well as a 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). Patients with such severe congenital immunodeficiencies appear to be in perfect health at birth, yet show initial manifestations of SCID between the 14th day and the 4th month following birth; in patients with XLA usually between the 8th and 16th month after birth. Albeit increasingly becoming appreciated as a relevant health problem, there is a lack of diagnostic procedures and screening profiles that would allow earliest possible diagnosis of patients with severe PID on a population scale. As a superior prognosis could be given upon prompt diagnosis and immediate adequate treatment, one strategy to improve the outcome of severe PID shall be to test newborns for the presence of T and B cells. With the aim to develop a simple and reliable test for newborn screening using the established dried blood sampling system (Guthrie cards), a multiplex real-time quantitative qPCR assay for the quantitation of T cell receptor excision circles (TRECs) and kappa-deleting recombination excision circles (KRECs) as surrogate markers of T and B cell development was designed and evaluated (publication I). This assay was further extended to allow detection of newborns with an inversion of the UNC13D gene, causing a severe PID characterized as familial hemophagocytic lymphohistiocytosis (publication III). Furthermore, the feasibility to identify several other severe PID, characterized by a functional defect of T- and B-cell interation (combined immunodeficiency diseases), was assessed using IgA-protein detection in neonatal Guthrie cards. However, this assay provided evidence of a maternal transfer mechanism for IgA, thereby preventing the use of this assay as a screening tool for severe PID (publication II). Finally, the TREC-KREC newborn screening assay was further improved in terms of assay performance and evaluated in retrospective cohorts of patients with the DiGeorge syndrome, or Down syndrome (publications IV and V). In addition, novel second-tier assays for comfirmation of the 22q11 microdeletion or the chromosome 21 triplication have been designed and succesfully tested with neonatal samples. In summary, new assays and concepts for newborn screening of severe primary immunodeficeincies were designed and benchmarked in retrospective and prospective neonatal dried blood spot samples, thereby underlining the potential of this preventive health care strategy.
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| 4. |
- Borte, Stephan, et al.
(författare)
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Newborn screening for severe T and B cell lymphopenia identifies a fraction of patients with Wiskott-Aldrich syndrome.
- 2014
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Ingår i: Clinical immunology (Orlando, Fla.). - : Elsevier BV. - 1521-7035 .- 1521-6616. ; 155:1, s. 74-78
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Tidskriftsartikel (refereegranskat)abstract
- The lack or marked reduction of recently formed T and B cells provides a basis for neonatal screening for severe combined immunodeficiencies (SCID) and X-linked agammaglobulinemia (XLA). Newborns with other conditions are also identified if a severe T or B cell lymphopenia is present at birth. We retrospectively analyzed Guthrie card samples from 11 children with Wiskott-Aldrich syndrome (WAS), a rare disease that requires early diagnosis and treatment, to determine whether combined T-cell receptor excision circle (TREC) and kappa-deleting recombination excision circle (KREC) screening could identify these patients. 4 of 11 patients showed markedly reduced TREC or KREC copy numbers in their DBS as compared to storage-time matched controls and prospectively screened Swedish and German newborns. No correlation was observed between the WAS gene mutations, the clinical severity/course and the result of the screening assay. A diagnosis of WAS should thus be considered in newborns with positive TREC or KREC screening results.
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| 5. |
- la Marca, Giancarlo, et al.
(författare)
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Diagnosis of immunodeficiency caused by a purine nucleoside phosphorylase defect by using tandem mass spectrometry on dried blood spots.
- 2014
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Ingår i: Journal of Allergy and Clinical Immunology. - : Elsevier BV. - 1097-6825 .- 0091-6749. ; 134:1, s. 155-155
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Tidskriftsartikel (refereegranskat)abstract
- Purine nucleoside phosphorylase (PNP) deficiency is a rare form of autosomal recessive combined primary immunodeficiency caused by a enzyme defect leading to the accumulation of inosine, 2'-deoxy-inosine (dIno), guanosine, and 2'-deoxy-guanosine (dGuo) in all cells, especially lymphocytes. Treatments are available and curative for PNP deficiency, but their efficacy depends on the early approach. PNP-combined immunodeficiency complies with the criteria for inclusion in a newborn screening program.
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| 6. |
- Lingman Framme, Jenny, 1977, et al.
(författare)
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Long-Term Follow-Up of Newborns with 22q11 Deletion Syndrome and Low TRECs
- 2022
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Ingår i: Journal of Clinical Immunology. - : Springer. - 0271-9142 .- 1573-2592. ; 42, s. 618-633
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Tidskriftsartikel (refereegranskat)abstract
- Background: Population-based neonatal screening using T-cell receptor excision circles (TRECs) identifies infants with profound T lymphopenia, as seen in cases of severe combined immunodeficiency, and in a subgroup of infants with 22q11 deletion syndrome (22q11DS).Purpose: To investigate the long-term prognostic value of low levels of TRECs in newborns with 22q11DS.Methods: Subjects with 22q11DS and low TRECs at birth (22q11Low, N=10), matched subjects with 22q11DS and normal TRECs (22q11Normal, N=10), and matched healthy controls (HC, N=10) were identified. At follow-up (median age 16 years), clinical and immunological characterizations, covering lymphocyte subsets, immunoglobulins, TRECs, T-cell receptor repertoires, and relative telomere length (RTL) measurements were performed.Results: At follow-up, the 22q11Low group had lower numbers of naïve T-helper cells, naïve T-regulatory cells, naïve cytotoxic T cells, and persistently lower TRECs compared to healthy controls. Receptor repertoires showed skewed V-gene usage for naïve T-helper cells, whereas for naïve cytotoxic T cells, shorter RTL and a trend towards higher clonality were found. Multivariate discriminant analysis revealed a clear distinction between the three groups and a skewing towards Th17 differentiation of T-helper cells, particularly in the 22q11Low individuals. Perturbations of B-cell subsets were found in both the 22q11Low and 22q11Normal group compared to the HC group, with larger proportions of naïve B cells and lower levels of memory B cells, including switched memory B cells.Conclusions: This long-term follow-up study shows that 22q11Low individuals have persistent immunologic aberrations and increased risk for immune dysregulation, indicating the necessity of lifelong monitoring.Clinical Implications: This study elucidates the natural history of childhood immune function in newborns with 22q11DS and low TRECs, which may facilitate the development of programs for long-term monitoring and therapeutic choices.
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| 7. |
- Lingman Framme, Jenny, 1977, et al.
(författare)
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Retrospective analysis of TREC based newborn screening results and clinical phenotypes in infants with the 22q11 deletion syndrome.
- 2014
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Ingår i: Journal of clinical immunology. - : Springer Science and Business Media LLC. - 1573-2592 .- 0271-9142. ; 34:4, s. 514-9
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Tidskriftsartikel (refereegranskat)abstract
- Population-based newborn screening using T-cell receptor excision circles (TREC) identifies infants with severe T-lymphopenia, seen in severe combined immunodeficiencies (SCID), but also infants with the 22q11 deletion syndrome (22q11DS). Methods for analysis of kappa-deleting recombination excision circles (KREC) help identifying infants with B-lymphopenia. We aimed to evaluate the occurrence of abnormal TREC or KREC newborn screening results in 22q11DS patients and assessed the clinical relevance of abnormal screening reports.
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| 8. |
- Marcotte, Harold, et al.
(författare)
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Conversion of monoclonal IgG to dimeric and secretory IgA restores neutralizing ability and prevents Infection of Omicron lineages
- 2024
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Ingår i: Proceedings of the National Academy of Sciences of the United States of America. - : NATL ACAD SCIENCES. - 0027-8424 .- 1091-6490. ; 121:3
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Tidskriftsartikel (refereegranskat)abstract
- The emergence of Omicron lineages and descendent subvariants continues to present a severe threat to the effectiveness of vaccines and therapeutic antibodies. We have previ- ously suggested that an insufficient mucosal immunoglobulin A (IgA) response induced by the mRNA vaccines is associated with a surge in breakthrough infections. Here, we further show that the intramuscular mRNA and/or inactivated vaccines cannot suffi- ciently boost the mucosal secretory IgA response in uninfected individuals, particu- larly against the Omicron variant. We thus engineered and characterized recombinant monomeric, dimeric, and secretory IgAl antibodies derived from four neutralizing IgG monoclonal antibodies (mAbs 01A05, rmAb23, DXP-604, and XG014) targeting the receptor-binding domain of the spike protein. Compared to their parental IgG antibod- ies, dimeric and secretory IgAl antibodies showed a higher neutralizing activity against different variants of concern (VOCs), in part due to an increased avidity. Importantly, the dimeric or secretory IgAl form of the DXP-604 antibody significantly outperformed its parental IgG antibody, and neutralized the Omicron lineages BA.1, BA.2, and BA.4/5 with a 25- to 75-fold increase in potency. In human angiotensin converting enzyme 2 (ACE2) transgenic mice, a single intranasal dose of the dimeric IgA DXP-604 conferred prophylactic and therapeutic protection against Omicron BA.5. Thus, dimeric or secre- tory IgA delivered by nasal administration may potentially be exploited for the treatment Iand prevention of Omicron infection, thereby providing an alternative tool for combating immune evasion by the current circulating subvariants and, potentially, future VOCs.
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