1. Comparing the levels of CTLA-4-dependent biological defects in patients with LRBA deficiency and CTLA-4 insufficiency
- Author
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Mehmet C. Catak, Bengu Akcam, Sevgi Bilgic Eltan, Royala Babayeva, Ibrahim S. Karakus, Gamze Akgun, Dilek Baser, Alper Bulutoglu, Feyza Bayram, Nurhan Kasap, Ayca Kiykim, Gonca Hancioglu, Sefika I. Kokcu Karadag, Yasemin kendir Demirkol, Selime Ozen, Sukru Cekic, Dilek Ozcan, Neslihan Edeer Karaca, Ayse S. Sasihuseyinoglu, Murat Cansever, Esra Ozek Yucel, Zeynep Tamay, Derya U. Altintas, Cigdem Aydogmus, Fatih Celmeli, Haluk Cokugras, Nesrin Gulez, Ferah Genel, Ayse Metin, Sukru N. Guner, Necil Kutukculer, Sevgi Keles, Ismail Reisli, Sara S. Kilic, Alisan Yildiran, Elif Karakoc‐Aydiner, Bernice Lo, Ahmet Ozen, Safa Baris, and Catak M. C., Akcam B., Bilgic Eltan S., Babayeva R., Karakus I. S., Akgun G., Baser D., Bulutoglu A., Bayram F., Kasap N., et al.
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Lipopolysaccharides ,inborn errors of immunity ,ENDOCYTOSIS ,CTLA- 4 ,Immunology ,Life Sciences (LIFE) ,PHENOTYPES ,Sağlık Bilimleri ,Clinical Medicine (MED) ,DISEASE ,DEMETHYLATION ,Genel İmmünoloji ve Mikrobiyoloji ,Abatacept ,Yaşam Bilimleri ,Health Sciences ,ALERJİ ,Humans ,Immunology and Allergy ,CTLA-4 Antigen ,Klinik Tıp (MED) ,REGULATORY T-CELLS ,Adaptor Proteins, Signal Transducing ,IMMUNE DYSREGULATION ,Klinik Tıp ,İmmünoloji ,General Immunology and Microbiology ,MUTATIONS ,Temel Bilimler ,Life Sciences ,Forkhead Transcription Factors ,CLINICAL MEDICINE ,GENE ,Tıp ,FAMILY ,ALLERGY ,Treg ,Yaşam Bilimleri (LIFE) ,Medicine ,T follicular helper cells ,CTLA-4 ,İmmünoloji ve Alerji ,LRBA ,Natural Sciences - Abstract
© 2022 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.Background: Lipopolysaccharide-responsive beige-like anchor protein (LRBA) deficiency and cytotoxic T-lymphocyte protein-4 (CTLA-4) insufficiency are recently described disorders that present with susceptibility to infections, autoimmunity, and lymphoproliferation. Clinical and immunological comparisons of the diseases with long-term follow-up have not been previously reported. We sought to compare the clinical and laboratory manifestations of both diseases and investigate the role of flow cytometry in predicting the genetic defect in patients with LRBA deficiency and CTLA-4 insufficiency. Methods: Patients were evaluated clinically with laboratory assessments for lymphocyte subsets, T follicular helper cells (TFH), LRBA expression, and expression of CD25, FOXP3, and CTLA4 in regulatory T cells (Tregs) at baseline and 16 h post-stimulation. Results: LRBA-deficient patients (n = 29) showed significantly early age of symptom onset, higher rates of pneumonia, autoimmunity, chronic diarrhea, and failure to thrive compared to CTLA-4 insufficiency (n = 12). In total, 29 patients received abatacept with favorable responses and the overall survival probability was not different between transplanted versus non-transplanted patients in LRBA deficiency. Meanwhile, higher probability of survival was observed in CTLA-4-insufficient patients (p = 0.04). The T-cell subsets showed more deviation to memory cells in CTLA-4-insufficiency, accompanied by low percentages of Treg and dysregulated cTFH cells response in both diseases. Cumulative numbers of autoimmunities positively correlated with cTFH frequencies. Baseline CTLA-4 expression was significantly diminished in LRBA deficiency and CTLA-4 insufficiency, but significant induction in CTLA-4 was observed after short-term T-cell stimulation in LRBA deficiency and controls, while this elevation was less in CTLA-4 insufficiency, allowing to differentiate this disease from LRBA deficiency with high sensitivity (87.5%) and specificity (90%). Conclusion: This cohort provided detailed clinical and laboratory comparisons for LRBA deficiency and CTLA-4 insufficiency. The flow cytometric approach is useful in predicting the defective gene; thus, targeted sequencing can be conducted to provide rapid diagnosis and treatment for these diseases impacting the CTLA-4 pathway.
- Published
- 2022