Frequency of a FAS ligand gene variant associated with inherited feline autoimmune lymphoproliferative syndrome in British shorthair cats in New Zealand.

AIMS To determine the frequency of the FAS-ligand gene (FASLG) variant associated with feline autoimmune lymphoproliferative syndrome (FALPS) and the proportion of carriers of the variant in three British shorthair (BSH) breeding catteries in New Zealand. METHODS Buccal swabs were collected from all cats in two BSH breeding catteries from the South Island and one from the North Island of New Zealand. DNA was extracted and was tested for the presence of the FASLG variant using PCR. Cats with the FASLG variant were identified and the frequency of the FASLG variant allele calculated. Pedigree analysis was performed and inbreeding coefficients were calculated for cats with the FASLG variant. RESULTS Of 32 BSH cats successfully tested for the presence of the FASLG variant, one kitten (3%) was homozygous (FALPS-affected), and seven (22%) cats were heterozygous (carriers) for the FASLG variant allele, and 24 (75%) cats were homozygous for the wild type allele. The overall frequency of the FASLG variant allele in these 32 cats was 0.14. Cats carrying the FASLG variant were from all three breeding catteries sampled, including two catteries that had not previously reported cases of FALPS. Pedigree analysis revealed common ancestry of FALPS-affected and carrier cats within six generations, as well as frequent inbreeding, with inbreeding coefficients >0.12 for five cats with the FASLG variant. CONCLUSIONS AND CLINICAL RELEVANCE There was a high frequency of the FASLG variant allele (0.14) in this small sample of BSH cats, with 22% of healthy cats identified as carriers of the FASLG variant. For an inherited disease, lethal at a young age, in a small population in which inbreeding is common, these results are significant. To prevent future cases of disease and stop further spread of the FASLG variant allele within the BSH population in New Zealand, it is recommended that all BSH and BSH-cross cats be tested for the presence of the FASLG variant before mating. Cats identified as carriers of the variant allele should be desexed and not used for breeding. Results support the need for further investigations of the true frequency of the FASLG variant allele and occurrence of FALPS in the wider population of BSH cats in New Zealand.

Defective anti-polysaccharide response and splenic marginal zone disorganization in ALPS patients.

Autoimmune lymphoproliferative syndrome (ALPS) caused by impaired FAS-mediated apoptosis of lymphocytes is characterized by lymphoproliferation, autoimmunity, but also an increased risk of invasive bacterial infection, notably following splenectomy. We surveyed a cohort of 100 ALPS patients (including 33 splenectomized) and found that 12 (10 splenectomized) had experienced 23 invasive bacterial infections mainly caused by Streptococcus pneumoniae. This vulnerability was associated with evidence of defective B-cell function characterized by low serum immunoglobulin (Ig) M, low IgM antibody production in response to S pneumoniae following nonconjugated immunization, and low blood memory B-cells counts (including marginal zone [MZ] B-cell counts). This immunodeficiency strongly correlated with intensity of lymphoproliferation. Spleen sections from 9 ALPS patients revealed double-negative T-cell (DN-T) infiltration of the MZ, which was depleted of B cells. MZ in ALPS patients contained an abnormally thick layer of MAdCAM-1((+)) stromal cells and an excess of DN-Ts. DN-Ts were shown to express MAdCAM-1 ligand, the α4ß7 integrin. These observations suggest that accumulating DN-Ts are trapped within stromal cell meshwork and interfere with correct localization of MZ B cells. Similar observations were made in spleens of fas-deficient mice. Our data revealed an unexpected mechanism by which ALPS results in anti-polysaccharide IgM antibody production-specific defect. Splenectomy should be avoided.

A survey of 90 patients with autoimmune lymphoproliferative syndrome related to TNFRSF6 mutation.

Autoimmune lymphoproliferative syndrome (ALPS) is a genetic disorder characterized by early-onset, chronic, nonmalignant lymphoproliferation, autoimmune manifestations, and susceptibility to lymphoma. The majority of ALPS patients carry heterozygous germline (ALPS-FAS) or somatic mutations (ALPS-sFAS) of the TNFRSF6 gene coding for FAS. Although the clinical features of ALPS have been described previously, long-term follow-up data on morbidity and mortality are scarce. We performed a retrospective analysis of clinical and genetic features of 90 ALPS-FAS and ALPS-sFAS patients monitored over a median period of 20.5 years. Heterozygous germline mutations of TNFRSF6 were identified in 83% of probands. Somatic TNFRSF6 mutations were found in 17% of index cases (all located within the intracellular domain of FAS). Sixty percent of the ALPS-FAS patients with mutations in the extracellular domain had a somatic mutation affecting the second allele of TNFRSF6; age at onset was later in these patients. No other genotype-phenotype correlations could be found. Long-term analysis confirmed a trend toward spontaneous remission of lymphoproliferation in adulthood but mixed outcomes for autoimmune manifestations. We observed significant and potentially life-threatening disease and treatment-related morbidity, including a high risk of sepsis after splenectomy that calls for careful long-term monitoring of ALPS patients. We also noted a significantly greater occurrence of disease-related symptoms in male than in female patients.

The autoimmune lymphoproliferative syndrome: A rare disorder providing clues about normal tolerance.

The autoimmune lymphoproliferative syndrome (ALPS) is characterized by chronic, non-malignant lymphoproliferation, autoimmunity often manifesting as multilineage cytopenias, and an increased risk of lymphoma. While considered a rare disease, there are currently over 250 patients with ALPS being followed at the National Institutes of Health in Bethesda, Maryland. Most of these patients have a mutation in the gene for the TNF receptor-family member Fas (CD 95, Apo-1), and about one-third have an unknown defect or mutations affecting function of other signaling proteins involved in the apoptotic pathway. While ALPS is one of the few autoimmune diseases with a known genetic defect, there remain unanswered questions regarding how a defect in apoptosis results in the observed phenotype. In addition to shedding light on the pathophysiology of this rare and fascinating condition, studying ALPS may improve our understanding of normal tolerance and more common, sporadic autoimmune disorders.

Trasplante intestinal / Intestinal transplant

El fracaso intestinal (FI) es una patología compleja que debe ser atendida en Unidades de Rehabilitación Intestinal (URI). El tratamiento médico-quirúrgico y nutricional puede ser eficaz en muchos pacientes, pero en los caos refractarios el trasplante intestinal, (TI) es una alternativa razonable, aunque la mortalidad es considerable y las complicaciones frecuentes. La URI del Hospital Infantil La Paz ha evaluado a 192 pacientes con FI como candidatos potenciales a TI. La causa más frecuente del FI fue el síndrome de intestino corto (77%). Más del 50% alcanzaron la autonomía digestiva sin necesidad de TI. 92 pacientes fueron incluidos en el programa de nutrición parental (NP) domiciliaria. Desde octubre de 1999 se realizaron 70 trasplantes en 56 pacientes (23 intestinales, 20 hepatointestinales y 27 multiviscerales) con una supervivencia global del 68,5%, que ha mejorado en los últimos cinco años hasta el 80%. Todos los supervivientes, excepto uno, pudieron suspender la NP, más frecuentes, excluidas las infecciosas, fueron: rechazo (17%) síndrome linfoproliferativo (14%), enfermedad de injerto contra huésped (13%) y anemia hemolítica autoinmune (11%) (AU)

Intestinal failure is a complex syndrome that must be managed in Intestinal Rehabilitation Units. Medical, surgical and nutritional treatment can be useful in a lot of patients, but in refractory cases, intestinal transplant can be a reasonable choice. However, mortality is appreciable and complications are frequent. Intestinal Rehabilitation Unit of Hospital Infantil La Paz has assessed 192 patients affected of intestinal failure as potential candidates to intestinal transplant. The most frequent cause of intestinal failures was short bowel syndrome (77%). More than 50% achieved digestive autonomy without transplant. 92 patients were included in our home parenteral nutrition program. Since October 1999, 70 transplant were performed in 56 patients (23 insolated small bowel, 20 combined liver-small bowel and 27 multivisceral) with an overall survival of 68,5%, improving in the last five year to 80%. All survivors but one, could wean off parenteral nutrition with a normal physical and school activity. Most frequent complications, excluding infectious, were: rejection (17%), lymphoproliferative disease (14%), graft versus host disease (13%) and autoimmune hemolytic anemia (11%) (AU)