Asunto(s)
Linfohistiocitosis Hemofagocítica/diagnóstico , Linfohistiocitosis Hemofagocítica/terapia , Diagnóstico Diferencial , Humanos , Síndromes de Inmunodeficiencia/diagnóstico , Inflamación , Activación de Linfocitos , Linfohistiocitosis Hemofagocítica/genética , Linfohistiocitosis Hemofagocítica/fisiopatología , Linfocitos T Citotóxicos/citologíaRESUMEN
Mutations of the perforin gene (PRF1) are present in a proportion of patients with hemophagocytic lymphohistiocytosis (HLH). We found that all identified infants with HLH of African descent (17 from USA, 4 from Europe) have 50delT-PRF1 (16 homozygotes, 5 compound heterozygotes), accounting for the most frequently observed PRF1 mutation. Two additional patients with HLH, self-reporting as Hispanic, carried 50delT, but no Caucasians were identified with 50delT. To test the hypothesis that this mutation represents a single haplotype, DNA from 23 patients with HLH and 30 African-American control subjects was sequenced for the PRF1 gene, including portions of the intron containing known single nucleotide polymorphisms (SNPs). The same groups were genotyped at 3 microsatellites proximal to PRF1. The SNP profiles of patients with 50delT-PRF1 were identical, and 5 novel SNPs were identified among African-American control subjects. Patients with 50delT-PRF1 were also found to have had an earlier age of disease onset than patients with other PRF1 mutations. Extent of haplotype sharing and variability of microsatellite alleles in 50delT-PRF1 chromosomes suggest that this mutation arose approximately 1000 to 4000 years ago and is restricted to patients of African descent.
Asunto(s)
Población Negra/genética , Haplotipos , Linfohistiocitosis Hemofagocítica/genética , Glicoproteínas de Membrana/genética , Mutación , Estudios de Casos y Controles , Niño , Preescolar , Europa (Continente) , Hispánicos o Latinos/genética , Humanos , Lactante , Linfohistiocitosis Hemofagocítica/etnología , Repeticiones de Microsatélite , Ohio , Perforina , Proteínas Citotóxicas Formadoras de Poros , Análisis de Secuencia de ADNRESUMEN
OBJECTIVES: To assess natural killer (NK) and cytotoxic functions in patients with systemic-onset juvenile rheumatoid arthrithis (soJRA) complicated by macrophage activation syndrome (MAS). METHODS: NK cells (CD56+/TCRalphabeta-), NK T cells (CD56+/TCRalphabeta+) and CD8+ cells were assessed for perforin expression by flow cytometry. NK cytotoxic activity was measured after coincubation of mononuclear cells with an NK-sensitive K562 cell line. RESULTS: Two major patterns of immunologic abnormalities were detected. Four of 7 patients had decreased NK activity, low NK cell numbers, and mildly increased levels of perforin expression in CD8+ and CD56+ cytotoxic cells. Three remaining patients with MAS, however, had decreased NK activity associated with low levels of perforin expression in all cytotoxic cell populations, a pattern indistinguishable from that in carriers of perforin-deficient familial hemophagocytic lymphohistiocytosis. Remarkably, two of these patients had previous episodes of MAS. CONCLUSIONS: NK dysfunction is an immunologic abnormality common to both familial hemophagocytic lymphohistiocytosis and MAS of soJRA. The extent of NK cell abnormalities in soJRA needs to be further investigated.