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Results for “Common Variable Immunodeficiency”

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PubMed1982

T-cell subpopulations defined with monoclonal antibodies in patients with primary immunodeficiency.

Peripheral blood mononuclear cells from 16 patients with common variable immunodeficiency and 4 with selective IgA deficiency were studied for the quantitative analysis of T-cells and T-cell subsets with distinct immunoregulatory properties, using a battery of monoclonal antibodies and the fluorescence-activated cell-sorter. The proportions of OKT4+ cells were decreased and OKT8+ cells were increased in patient groups when compared to normal controls analyzed simultaneously. 14/20 (70%) patients demonstrated a lower OKT4+/OKT8+ cell ratio compared to controls. Imbalance of immunoregulatory T-cells may explain one of the mechanisms of hypogammaglobulinemia in a subgroup of patients with primary immunodeficiency.

Adolescent↗

PubMed1996

[Laboratory markers in hepatitis C virus infection in patients with antibody formation disorders treated with immunoglobulin preparations].

The presence of hepatitis C virus (HCV) was investigated in 20 agammaglobulinemic patients using polymerase chain reaction (PCR) and by specific anti-HCV antibodies detection. Fourteen patients suffered from common variable immunodeficiency (CVID), 5 patients from X-linked agammaglobulinemia and one from specific antibody-formation deficiency. All patients were treated by the replacement immunoglobulin therapy (6-30 years), in 19 of them also intravenous immunoglobulin was used. Although 2 patients suffered from chronic hepatic disease (chronic active hepatitis and granulomatous hepatitis of unknown origin), in none of the investigated patients any laboratory marker of HCV infection was proved. Although no HCV infection was observed in our group of patients, PCR for HCV-RNA should be performed in all patients previously treated by the intravenous immunoglobulin.

Adult↗

PubMed2004

Echocardiographic abnormalities in primary antibody deficiency.

OBJECTIVE: To document cardiac abnormalities secondary to pulmonary disease in primary antibody deficiency. PATIENTS AND METHODS: A cross sectional audit study of patients from a regional immunology centre. Subjects undergoing two dimensional and Doppler transthoracic echocardiography were reviewed. Ventricular dimensions and function, valvular competence, and estimated pulmonary artery pressure were recorded. Data were compared with clinical variables, pulmonary function tests, and thoracic computed tomography data. RESULTS: Nineteen patients with common variable immunodeficiency and one with IgG(2) subclass deficiency were included, mean age at diagnosis 37.5 years, mean estimated diagnostic delay 10.94 years. Left ventricular impairment was found in 15% and right heart dilatation in 20%. Pulmonary hypertension (mean pulmonary artery pressure >25 mm Hg) was found in 45% (9/20), graded as moderate (40-60 mm Hg) in 44% of cases. Pulmonary function was obstructive in 47% (9/19). Fifty five percent of the patients with computed tomography data within the last five years (10/18) had confirmed bronchiectasis. Patients with right heart dilatation and/or moderate pulmonary hypertension (n = 6) had a more prolonged diagnostic delay (p = 0.04) and more severe lung disease. CONCLUSION: Echocardiographic abnormalities are common in primary antibody deficiency, associated with diagnostic delay and pulmonary complications. Pulmonary hypertension should be considered in those with severe lung disease and can be confirmed by echocardiography.

Adult↗

PubMed1994

Effect of IL-2 on immunoglobulin production by anti-CD40-activated human B cells: synergistic effect with IL-10 and antagonistic effect with IL-4.

Activation of B cells by anti-CD40 provides an excellent model to investigate the direct effect of various cytokines on Ig production. Using this culture system, we examined the effect of IL-2 alone or in combination with other cytokines. IL-2 alone had only a moderate effect on Ig production by anti-CD40-activated B cells if compared with the effect of IL-10. However, IL-2 significantly augmented the synthesis of IgM, IgA, and IgG, including all IgG subclasses by anti-CD40-activated B cells cultured in the presence of IL-10. Both IgD- and IgD+ B cells showed an increase of IL-10-induced Ig production if IL-2 was added to the culture. The addition of IL-2 also increased immunoglobulin synthesis by anti-CD40/IL-10-activated B cells from patients with common variable immunodeficiency (CVI) and defective IL-2 production, suggesting that in a subgroup of CVI patients the IL-2 deficiency may contribute to the observed hypogammaglobulinemia. In contrast, the addition of IL-2 had a suppressive effect on IgE and IgG4 production by B cells cultured in the presence of anti-CD40 and IL-4. These data demonstrate that IL-2 plays an active role in the regulation of Ig production via CD40 by anti-CD40-activated B cells.

Adult↗

PubMed1994

[Clinical implication of IL-10 in patients with immune and inflammatory diseases].

The immune system is regulated by soluble glycoproteins produced by a wide variety of cells. IL-10 is a soluble protein produced by helper T (Th) cells, macrophages (M phi)/monocytes (Mo), and B cells, which exhibits a wide array of both immunosuppressive and immunostimulatory properties. We examined the pathological significance of this new cytokine "IL-10", and its clinical implications. IL-10 was discovered in 1989 as an activity produced by murine type 2Th (Th2) cells which suppressed cytokine production such as interferon gamma (IFN gamma) by type 1Th (Th1) cells. Its inhibitory effects were mainly recognized in vivo in animal experiments. In humans, unlike in mice, it is difficult to separate Th1 from Th2 cells. However, as we expected, marked suppressive activities on M phi/Mo were observed in humans. We have examined the serum levels of IL-10 in several diseases. In autoimmune diseases, some of the patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) had higher titers of IL-10 in their sera than the normal controls. Conversely, some patients with common variable immunodeficiency and with inflammatory bowel diseases showed lower titers of IL-10 in their sera than the healthy controls. Most bacterial endotoxin shock patients had lower levels of serum IL-10 than cardiogenic shock patients. Collectively, the ability of IL-10 to suppress the production of inflammatory monokines and to elevate anti-inflammatory monokines, suggests a strong anti-inflammatory role in diseases such as septic endotoxin shock and inflammatory bowel diseases. Also, the IL-10 antagonist such as soluble IL-10 receptor might be a candidate for the treatment of B cell mediated autoimmune diseases such as SLE by selectively enhancing Th1 immunity.

Amino Acid Sequence↗

PubMed1997

Mycoplasma felis septic arthritis in a patient with hypogammaglobulinemia.

We describe the first documented case of Mycoplasma felis infection in a woman who had common variable immunodeficiency and who presented with septic arthritis of the left hip and right knee. M. felis was isolated from both joints. She had been exposed to cats before the diagnosis of M. felis septic arthritis was made. Both of the patient's joints were surgically debrided, and she was treated with doxycycline for several months. In spite of initial improvement, destruction of her hip was noted. Subsequently, she underwent hip arthroplasty; histopathological examination of the bone at the time of surgery showed chronic osteomyelitis, and doxycycline therapy was continued.

Agammaglobulinemia↗

PubMed1997

[Subcutaneous immunoglobulin infusion in antibody deficiency substitution of a patient sensitized to intravenous immunoglobulins. Case report].

Patients with severe form of common variable immunodeficiency require chronic immunoglobulin substitution. However, intravenous Ig administration may not be possible in some of them because of serious anaphylactoid reactions. It has been suggested that such patients may tolerate well Ig administration by subcutaneous infusion. A case is described (originally with IgG level of 53 mg/dl) who reacted with anaphylactic shock to intravenous immunoglobulin and now for more than 7 months at 1-2 week intervals receives immunoglobulin by subcutaneous infusion without any adverse reactions and maintaining IgG level above 400 mg/dl. In contrast to the period proceeding immunoglobulin substitution, the patient remains free of bacterial infection during last 7 months.

Common Variable Immunodeficiency↗

PubMed2003

Lymphoproliferative disease in antibody deficiency: a multi-centre study.

We have undertaken a retrospective study of antibody deficient patients, with and without lymphoma, and assessed the ability of specific polymerase chain reaction (PCR) primers to determine if the detection of clonal lymphocyte populations correlates with clinical and immunohistochemical diagnosis of lymphoma. We identified 158 cases with antibody deficiency presenting during the past 20 years. Paraffin-embedded biopsy specimens or slides were available for analysis in a cohort of 34 patients. Of these patients, 29 had common variable immunodeficiency, one X-linked agammaglobulinaemia, one X-linked immunoglobulin deficiency of uncertain cause and three isolated IgG subclass deficiency. We have confirmed that lymphoma in antibody deficiency is predominantly B cell in origin. Clonal lymphocyte populations were demonstrated in biopsies irrespective of histology (16/19 with lymphoma and 11/15 without). Isolated evidence of clonality in biopsy material is therefore an insufficient diagnostic criterion to determine malignancy. Furthermore, our data suggest that clonal expansions are rarely the result of Epstein-Barr virus-driven disease.

Adult↗

PubMed2002

[Efficacy of cyclines in agammaglobulinemia arthritis].

Five to 40% of patients with agammaglobulineamia develop joint manifestation consisting of septic arthritis or aseptic arthritis of unclear pathogenesis. Intravenous gamma-globulin therapy seems effective on the better condition but is burden-some and expensive. We report the case of a 31-year old woman, having a common variable immunodeficiency that has a chronic oligoarthritis seronegative and not warping. Substitutive treatment with gamma-globulins resulted in a poor improvement. Blood Lymphocyte immunotyping ans analysis of synovial fluid showed high levels of CD8 with a low CD4/CD8 ratio. Synovial biopsy revealed a non specific synovitis with an lymphoid aggregates with a significant predominance of CD8 cells and suspicion of mycoplasm, only after centrifugation, justifying PCR techniques. Doxycycline therapy was effective in relieving the joint symptoms with six month recession.

Adult↗

PubMed1995

[Personal experience with replacement therapy with intravenous gamma globulin].

Replacement therapy with intravenous immunoglobulin (IVIG) is currently the therapy of choice in patients with antibody-formation deficiency. Our 30-month experience with IVIG treatment in 8 patients with common variable immunodeficiency and in 4 patients with x-linked agammaglobulinemia previously treated by intramuscular immunoglobulin or low-dose IVIG is presented. Long-term dosage was 400 mg/kg once in 3--4 weeks. Ten patients reported an improvement of their health state, especially the signs of their chronic bronchitis improved. Compared to 2 cases of pneumonia which occurred within 30 months before IVIG therapy had started, no case of pneumonia occurred during IVIG treatment. Infusion rate of 4 mg/kg/min was safe enough in 11 of our patients. Serum trough IgG level is the most important for laboratory monitoring of the patients under IVIG therapy.

Adult↗

PubMed1994

CD58 (LFA-3) stimulation provides a signal for human isotype switching and IgE production distinct from CD40.

Induction of an IgE response involves several discrete steps: 1) induction of epsilon germ line transcription, 2) DNA recombination, and 3) mature RNA transcription/translation. Here we show that ligation of B cell CD58 by CD2, its natural ligand on T cells, or by mAb, provides a novel IL-4-dependent signal for the latter two steps. Highly purified human B cells were induced to produce IgE by costimulation with IL-4 and CD58 mAb. Although CD58 ligation alone was unable to induce epsilon germ-line transcription, in concert with IL-4-stimulated epsilon germ-line transcription it induced the appearance of productive epsilon transcripts and IgE production. The direct involvement of CD2 was demonstrated: B cells cultured with IL-4 plus murine T hybridoma cells transfected with human CD2 produced IgE. A CD40 Fc fusion protein had no effect on CD58-driven IgE production while inhibiting CD40-dependent responses. Furthermore, cells from patients with common variable immunodeficiency produced IgE in response to IL-4 plus CD40 mAb but not to IL-4 plus CD58 mAb. CD58-driven IgE synthesis was IFN-gamma independent and was not enhanced by exogenous IL-6. Functional differences between CD40 and CD58 IgE stimulation were demonstrated. Thus, the CD2:CD58 ligand/counterligand system provides an alternative pathway by which cell contact signaling may regulate IgE. Given the relative importance of CD2 triggering on mucosal T cells and the mucosal location of IgE production, this may be especially true on mucosal surfaces.

Adult↗

PubMed1993

Abnormalities of lymphocyte subpopulations in CVI do not correlate with increased production of IL-6.

We have determined the percentages and absolute numbers of lymphocyte subpopulations in 49 patients with common variable immunodeficiency (CVI). In vitro production of IL-6 by PHA-stimulated PBMC of 28 patients was also evaluated. Our data indicate profound alterations in the lymphocyte subpopulations evaluated, including increased CD8 cells (these cells outnumbered CD4 cells in 26 cases), severe defect of CD4 cells (< 400/mm3) in 10 cases and reduction of CD19 cells (< 50/mm3) in 11/41 cases. Increased production in vitro of IL-6 by PBMC of CVI patients does not correlate with the absolute numbers of lymphocytes, lymphocyte subpopulations, or monocytes. In addition, IL-6 was unable to significantly modify the amount of PWM-driven IgM production by CVI cells.

Adolescent↗

PubMed1995

Mediastinal lymph node enlargement and splenomegaly in primary hypogammaglobulinaemia.

The computed tomography (CT) scans of 37 patients with primary hypogammaglobulinaemia were reviewed to determine the frequency of enlarged mediastinal lymph nodes and splenomegaly in this group. None of the 10 X-linked Agammaglobulinaemia (XLA) patients had enlarged nodes and only one had splenomegaly. Eleven of the 27 Common Variable Immunodeficiency (CVID) group had enlarged nodes (41%) and 13 had splenomegaly (48%). There was no significant correlation between the presence of enlarged nodes and splenic enlargement. Twenty-two patients had bronchiectasis but the presence of bronchiectasis did not correlate with the presence of either splenomegaly or lymphadenopathy. Three to 6 years follow-up is available for 36 of the 37 patients and none of this group have developed lymphoma or other malignancy. Enlarged mediastinal nodes and/or splenomegaly are frequently found in patients with CVID and are usually due to a benign, non-neoplastic, process. Mediastinal lymph node enlargement is not a feature of XLA and splenomegaly is unusual in this condition.

Adolescent↗

PubMed2000

IgA deficiency in Czech healthy individuals and selected patient groups.

BACKGROUND: Selective IgA deficiency (IgAD) is the most common immunoglobulin deficiency with a variety of clinical manifestations. The frequency of IgAD differs depending on the ethnic origin and clinical symptoms of investigated persons. METHODS: The prevalence of IgAD (serum IgA level <0.05 g/l) was determined in 5,310 Czech blood donors, 10,326 patients who had undergone immunological investigation, and 246 first-degree relatives of IgAD and common variable immunodeficiency (CVID) patients. RESULTS: IgAD was detected in 13 (1/408; 0.24%) of the blood donors. The prevalence of IgAD was increased both in children (48/3,113; 1.5%) and adults (33/3,824; 0.9%) referred for frequent respiratory tract infections (in both cases p<0.001) compared to the healthy population. The frequency of IgAD was 12/189 (6%) in first-degree relatives of IgAD patients and 9/57 (16%) in relatives of CVID patients, with the highest frequency observed in children of CVID patients. CONCLUSIONS: The prevalence of IgAD in the Czech healthy population is comparable to that in other Caucasians. The frequency is increased in children with recurrent respiratory tract infections and especially in relatives of patients with immunoglobulin deficiencies.

Adolescent↗

PubMed2005

Association of secondary amyloidosis with common variable immune deficiency and tuberculosis.

This paper describes the first case of common variable immunodeficiency (CVID) and AA amyloidosis. A recently treated tuberculosis, and chronic inflammation induced by frequent respiratory tract infections, were thought to be responsible for the amyloidosis. No other reason for this condition could be detected. Although T cell dysfunction in some CVID patients has been reported, pulmonary tuberculosis is quite rare with this condition. Bacterial or viral agents or evidence in favour of intestinal tuberculosis, which would explain this patient's recurrent diarrhea, were not found. In this case, the response of the attacks of diarrhea to metranidazole and the histologic observation of extensive intestinal amyloid deposition, which is known to decrease intestinal motility, made us conclude that the diarrhea was associated with bacterial overgrowth. In this report, we discuss the association of CVID and tuberculosis to secondary amyloidosis and recurrent diarrhea.

Adult↗

PubMed1994

Serum soluble CD23 in patients with hypogammaglobulinaemia.

Serum levels of the soluble form of the low-affinity receptor for IgE (FcERII, CD23) (sCD23) are elevated in autoimmune conditions associated with hypergammaglobulinaemia and B cell hyperactivity. Very high levels of sCD23 are found in patients with B-chronic lymphatic leukaemia (B-CLL) who are, however, frequently hypogammaglobulinaemic. We therefore compared the serum levels of sCD23 in healthy controls (n = 33) with three conditions associated with hypogammaglobulinaemia (HGG) and varying B cell numbers: X-linked agammaglobulinaemia (XLA, n = 12), common variable immunodeficiency (CVI, n = 20) and B-chronic lymphatic leukaemia (n = 33). Serum levels of sCD23 showed a significant correlation with the CD19+ B cell count in both normals and patients with CVI (r = 0.65, P < 0.0001). Amongst the different clinical groups, serum levels of sCD23 were increased in the order XLA < CVI < normals < CLL (medians 2.5, 7.7, 11.1 and 540, respectively; P < 0.001 for all comparisons except CVI versus normals P < 0.03 in a one-tailed test). In the CVI group, serum sCD23 was lowest amongst four patients with low B cell numbers. There was no overlap in sCD23 between patients with XLA and this subgroup of CVI patients. Serum sCD23 is, therefore, derived predominantly from B cells, and is significantly related to the peripheral blood B cell count.

Agammaglobulinemia↗

PubMed2000

Bilateral consecutive central corneal perforations associated with hypogammaglobulinemia.

OBJECTIVE: To describe the presentation and the clinical course of a patient with consecutive central sterile corneal perforations associated with common variable immunodeficiency. DESIGN: Case report. METHODS: Multiple corneal cultures and scrapings were performed in an effort to identify an infectious cause and all were negative. Corneal biopsy did not demonstrate any evidence of micro-organisms. An extended investigation failed to uncover a collagen vascular cause or atopy. RESULTS: Progressive sterile stromal thinning with intact epithelium in the left eye proceeded to perforation despite topical treatment, and cyanoacrylate gluing was performed. However, a secondary Haemophilus influenza endophthalmitis developed, and the eye was eventually lost. The fellow eye proceeded along the same clinical course with sterile stromal thinning. A lamellar patch graft was performed when the central ulceration progressed to a descemetocele. The eye remained quiet with 20/25 vision for 2 years, until the patient died from complications of a liver transplant. CONCLUSIONS: Devastating central sterile corneal thinning leading to perforation may occur in patients with hypogammaglobulinemia.

Agammaglobulinemia↗

PubMed2006

De novo mutation in the BTK gene of atypical X-linked agammaglobulinemia in a patient with recurrent pyoderma.

BACKGROUND: X-linked agammaglobulinemia (XLA), characterized by a profound deficiency of all immunoglobulins and the absence of mature B cells, is caused by mutations in the gene encoding Bruton tyrosine kinase (BTK). Most patients have recurrent sinopulmonary infection. Infections usually occur in multiple locations across time, but single infection may be limited to one anatomic location. OBJECTIVES: To report a case of atypical XLA with recurrent pyoderma and to observe the immunologic changes in the patient in 10 years. METHODS: Immunologic investigations, skin wound culture, and molecular study with DNA sequencing were performed. RESULTS: The patient was originally diagnosed as having common variable immunodeficiency disease because of the presence of circulating B cells (CD19+ B cells: 7%) at 11 years old. On further evaluation at the age of 20 years, flow cytometric analysis of lymphocytes showed only 0.4% B cells. The molecular study with DNA sequencing of the patient showed a point mutation in complementary DNA 1630 A>G(p.R544G) in the BTK gene, indicating that the patient has XLA. The mutation analysis of the BTK gene revealed a normal DNA sequence in the other family members. CONCLUSIONS: This case is an important example of a possible presentation of XLA with a predominant skin manifestation, and it demonstrates that maintaining a high level of clinical suspicion is essential for the diagnosis of XLA in a child with recurrent pyoderma.

Adolescent↗