Clinical, Immunological, and Molecular Findings in 57 Patients With Severe Combined Immunodeficiency (SCID) From India

Severe combined immunodeficiency (SCID) represents one of the most severe forms of primary immunodeficiency (PID) disorders characterized by impaired cellular and humoral immune responses. Here, we report the clinical, immunological, and molecular findings in 57 patients diagnosed with SCID from Ind...

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Bibliographic Details
Published in:	Frontiers in immunology Vol. 10; p. 23
Main Authors:	Aluri, Jahnavi, Desai, Mukesh, Gupta, Maya, Dalvi, Aparna, Terance, Antony, Rosenzweig, Sergio D, Stoddard, Jennifer L, Niemela, Julie E, Tamankar, Vasundhara, Mhatre, Snehal, Bargir, Umair, Kulkarni, Manasi, Shah, Nitin, Aggarwal, Amita, Lashkari, Harsha Prasada, Krishna, Vidya, Govindaraj, Geeta, Kalra, Manas, Madkaikar, Manisha
Format:	Journal Article
Language:	English
Published:	Switzerland Frontiers Media S.A 04-02-2019
Subjects:	Age of Onset AIDS-Related Opportunistic Infections - diagnosis Biomarkers CD4-CD8 Ratio Child, Preschool Combined Modality Therapy Disease Susceptibility Female flow cytometry Gene Expression Profiling Genetic Variation Humans Immunology India Infant Infant, Newborn Lymphocyte Count Male PID sanger sequencing Severe Combined Immunodeficiency - diagnosis Severe Combined Immunodeficiency - genetics Severe Combined Immunodeficiency - immunology Severe Combined Immunodeficiency - virology Symptom Assessment targeted next generation sequencing TREC India PID flow cytometry TREC targeted next generation sequencing sanger sequencing
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Summary:	Severe combined immunodeficiency (SCID) represents one of the most severe forms of primary immunodeficiency (PID) disorders characterized by impaired cellular and humoral immune responses. Here, we report the clinical, immunological, and molecular findings in 57 patients diagnosed with SCID from India. Majority of our patients (89%) presented within 6 months of age. The most common clinical manifestations observed were recurrent pneumonia (66%), failure to thrive (60%), chronic diarrhea (35%), gastrointestinal infection (21%), and oral candidiasis (21%). Hematopoietic Stem Cell Transplantation (HSCT) is the only curative therapy available for treating these patients. Four patients underwent HSCT in our cohort but had a poor survival outcome. Lymphopenia (absolute lymphocyte counts/μL <2,500) was noted in 63% of the patients. Based on immunophenotypic pattern, majority of the cases were T B SCID (39%) followed by T B SCID (28%). MHC class II deficiency accounted for 10.5% of our patient group. A total of 49 patients were molecularly characterized in this study and 32 novel variants were identified in our cohort. The spectrum of genetic defects in our cohort revealed a wide genetic heterogeneity with the major genetic cause being gene defect ( = 12) followed by ( = 9) and defects ( = 9). Rare forms of SCID like Purine nucleoside phosphorylase (PNP) deficiency, reticular dysgenesis, DNA-Protein Kinase (DNA-PKcs) deficiency, six cases of MHC class II deficiency and two ZAP70 deficiency were also identified in our cohort. Fourteen percent of the defects still remained uncharacterized despite the application of next generation sequencing. With the exception of MHC class II deficiency and ZAP70 deficiency, all SCID patients had extremely low T cell receptor excision (TRECs) (<18 copies/μL).
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Edited by: Waleed Al-Herz, Kuwait University, Kuwait This article was submitted to Primary Immunodeficiencies, a section of the journal Frontiers in Immunology Reviewed by: Kimberly Gilmour, Great Ormond Street Hospital for Children NHS Foundation Trust, United Kingdom; Monica Thakar, Fred Hutchinson Cancer Research Center, United States
ISSN:	1664-3224 1664-3224
DOI:	10.3389/fimmu.2019.00023