SDHA gain-of-function engages inflammatory mitochondrial retrograde signaling via KEAP1-Nrf2.

Whether screening the metabolic activity of immune cells facilitates discovery of molecular pathology remains unknown. Here we prospectively screened the extracellular acidification rate as a measure of glycolysis and the oxygen consumption rate as a measure of mitochondrial respiration in B cells from patients with primary antibody deficiency. The highest oxygen consumption rate values were detected in three study participants with persistent polyclonal B cell lymphocytosis (PPBL). Exome sequencing identified germline mutations in SDHA, which encodes succinate dehydrogenase subunit A, in all three patients with PPBL. SDHA gain-of-function led to an accumulation of fumarate in PPBL B cells, which engaged the KEAP1-Nrf2 system to drive the transcription of genes encoding inflammatory cytokines. In a single patient trial, blocking the activity of the cytokine interleukin-6 in vivo prevented systemic inflammation and ameliorated clinical disease. Overall, our study has identified pathological mitochondrial retrograde signaling as a disease modifier in primary antibody deficiency.

[Chronic myeloid leukemia - update 2020]. / Chronische Myeloische Leukämie ­ Update 2020.

Chronic myeloid leukemia - update 2020 Abstract. The discovery of specific inhibitors of the BCR-ABL tyrosine kinase more than 20 years ago has revolutionized the treatment of patients with chronic myeloid leukemia (CML). Prognosis and outcome of patients considerably improved and progress in the use of the tyrosine kinase inhibitors is ongoing. In comparison to imatinib, second generation inhibitors used in first line lead to faster and deeper molecular remissions accompanied by different adverse event profiles. An essential part of the management of CML patients is to assess regularly the remaining tumor load by standardized molecular methods. Based on several clinical trials definitions of optimal response to treatment and of treatment failure have been put forward and help guide the treatment of the patients. The concept of treatment free remission was investigated extensively and is now part of the management of CML patients. Advanced stages of CML are diagnosed less frequently but are still challenging to treat. In these cases, allogeneic transplantation still plays an important role in the attempt to control the disease.

[Anemia in the elderly - a diagnostic and therapeutic challenge?]. / Anämie im Alter - eine diagnostische und therapeutische Herausforderung.

Anemia in elderly patients should never be regarded as a normal physiological response to aging. The main categories of anemia in older patients are the nutritional anemia attributed to iron deficiency, including blood loss, folate and vitamin B12 deficiency, anemia of chronic disease in patients with cancer, infections and other chronic inflammation. A further category is the unexplained anemia due most probably to impaired corrective mechanisms to stress in older persons. Investigations such as a complete blood count, red cell indices and morphology, reticulocyte count, iron parameters, vitamin B12 and folate will detect the underlying disease in many cases, when anemia is classified according to red blood cell mean corpuscular volume. Microcytic anemia is typically for iron deficiency, but normocytic anemia can also be found in iron deficiency or anemia of chronic disease. Anemia due to vitamin B12 or folate deficiency is typically macrocytic. The treatment should aim to correct the underlying cause of disorder. Recombinant human erythropoietin is a standard treatment in anemia associated with chronic renal failure and tumor-associated anemia, but not in other forms of anemia. Regular blood transfusions may be required for elderly patients with chronic anemia.

Congenital dyserythropoietic anemia type I (CDA I): molecular genetics, clinical appearance, and prognosis based on long-term observation.

Congenital dyserythropoietic anemia type I (CDA I) is a rare autosomal recessive disorder with ineffective erythropoiesis and iron overloading. More than 100 cases have been described, but with the exception of a report on a large Bedouin tribe, these reports include only small numbers of cases, and no data on the lifetime evolution of the disease are available. Since 1967, we have been able to follow 21 cases from 19 families for up to 37 years. Twenty-one patients with a confirmed diagnosis of CDA I exhibited chronic macrocytic anemia of variable severity, requiring regular red cell transfusions only in 2 individuals. Four developed gallstones before the age of 30 years. Fifteen of 16 cases alive at the time of analysis showed mutations of at least one allele from exons 6 to 28 within CDAN1. Iron overloading is to be expected in all patients. In 9 patients, iron depletion was started between the ages of 7 and 36 years. Splenectomy, which was performed in 7 patients, did not result in improvement of hemoglobin values. Five patients were treated with interferon alpha-2a, and all responded with a rise in hemoglobin concentration of between 25 and 35 g/L (2.5 and 3.5 g/dL) starting within 4 weeks.