Adenosine deaminase and nucleoside phosphorylase activity in patients with immunodeficiency syndromes.
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Biomedical subjects
Publications and source records attributed to E R Giblett.
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Complete HLA typing including HLA--A, --B, --C, --DR (D related B cell typing), --D, mixed lymphocyte culture (MLC), and primed lymphocyte testing (PLT), together with complete red blood cell (RBC), glyoxalase (GLO), GBG (Factor B), and phosphoglucomutase 3 (PGM3) typings were performed on a informative family. The five siblings inherited the four possible combinations of parental HLA haplotypes, and two of the siblings were HLA--A, --B, --C and --DR identical. Repeated MLC testing of the family revealed positive mixed lymphocyte reactivity in all combinations. B cell typing for the DR specificities demonstrated no variation from the expected inheritance pattern and specifically no recombination event. GBG and GLO typings militated against a recombination involving the paternal chromosome. HLA--D testing revealed that only one of the HLA--A, --B, --C, and --DR identical siblings gave typing responses to the HLA--Dw3 specificity present on that maternal haplotype. Utilizing HLA haploidentical combinations, lymphocytes were primed against the four parental haplotypes and the non-Dw3 haplotype of interest (Aw24--B8--DRw3--LDY) in the PLT. The sibling inheriting this haplo-type did not restimulate cells primed against the A2--B40--DRW6--LDY specificity. Furthermore, no discrimination was observed in the restimulation of lymphocytes primed against this haplo-type. Possible interpretations of these family data include: a spontaneous mutation, non-major histocompatibility locus (MHC) stimulation, and HLA--DR/D recombination.
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Two brothers, age 9 and 11, respectively, have marked deficiency of nucleoside phosphorylase associated with defective T-cell function and normal B-cell function. Unlike the previously described five patients with this syndrome, each of these children has sufficient NP catalytic activity in their red blood cells (below 1% of the normal level) to be visualized after electrophoresis and staining for the enzyme. Their healthy sibling has normal NP activity and a normal isozyme pattern. The nonconsanguineous parents have about half-normal NP activity, but their electrophoretic patterns differ from each other's and from those of their affected children. These findings are consistent with genetic heterogeneity at the NP structural gene locus, resulting in compound heterozygosity for two different abnormal alleles.
Four patients with acute leukemia and one with aplastic anemia were not transfused within 90 days before marrow transplantation from the HLA-identical sibling. When studied 4 to 12 1/2 months after transplantation their immunoglobulin allotypes were those of their donors.
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Accumulation of adenine deoxynucleotides (dATP and dADP) in the erythrocytes of a patient with adenosine deaminase (ADA) deficiency was confirmed. The patient, now 18 mo old, was treated with a bone marrow transplantation from his HLA identical sister at 7 mo of age. Before and after the transplant, his erythrocyte and lymphocyte ADA activities, as well as his erythrocyte nucleotide profiles, were measured. 10 wk after the marrow transplant, no ADA activity could be detected in his erythrocytes, whereas there was a mixture of donor and patient lymphocytes as measured by ADA assays and karyotyping. At the same time, both dATP and dADP had disappeared from his erythrocytes, which were entirely of patient origin. These findings indicate that partial engraftment of donor lymphocytes into an ADA-deficient patient is capable of "correcting" alterations of deoxynucleotide concentrations in the patient's ADA-deficient erythrocytes.
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