; Lucena, Jose M. ; Seidl, Maximilian ; Schmitt-Graeff, Annette ; Reiser, Veronika ; Emmerich, Florian ; Frede, Natalie ; Bulashevska, Alla ; Salzer, Ulrich
; Schubert, Desirée ; Hayakawa, Seiichi ; Okada, Satoshi
; Kanariou, Maria ; Kucuk, Zeynep Yesim ; Chapdelaine, Hugo ; Petruzelkova, Lenka ; Sumnik, Zdenek
; Sediva, Anna ; Slatter, Mary ; Arkwright, Peter D. ; Cant, Andrew ; Lorenz, Hanns-Martin ; Giese, Thomas ; Lougaris, Vassilios ; Plebani, Alessandro ; Price, Christina ; Sullivan, Kathleen E. ; Moutschen, Michel ; Litzman, Jiri
; Freiberger, Tomas
; van de Veerdonk, Frank L. ; Recher, Mike ; Albert, Michael H. ; Hauck, Fabian
; Seneviratne, Suranjith ; Pachlopnik Schmid, Jana ; Kolios, Antonios
; Unglik, Gary ; Klemann, Christian
; Speckmann, Carsten
; Ehl, Stephan ; Leichtner, Alan ; Blumberg, Richard ; Franke, Andre ; Snapper, Scott ; Zeissig, Sebastian ; Cunningham-Rundles, Charlotte ; Giulino-Roth, Lisa ; Elemento, Olivier ; Dückers, Gregor ; Niehues, Tim ; Fronkova, Eva ; Kanderová, Veronika ; Platt, Craig D. ; Chou, Janet ; Chatila, Talal A.
; Geha, Raif ; McDermott, Elizabeth ; Bunn, Su ; Kurzai, Monika ; Schulz, Ansgar ; Alsina, Laia
; Casals, Ferran ; Deyà-Martinez, Angela ; Hambleton, Sophie ; Kanegane, Hirokazu ; Taskén, Kjetil
; Neth, Olaf ; Grimbacher, Bodo | Item type: | Article | ||||
|---|---|---|---|---|---|
| Journal or Publication Title: | Journal of Allergy and Clinical Immunology | ||||
| Publisher: | MOSBY-ELSEVIER | ||||
| Place of Publication: | NEW YORK | ||||
| Volume: | 142 | ||||
| Number of Issue or Book Chapter: | 6 | ||||
| Page Range: | pp. 1932-1946 | ||||
| Date: | 2018 | ||||
| Institutions: | Medicine > Lehrstuhl für Innere Medizin III (Hämatologie und Internistische Onkologie) | ||||
| Identification Number: |
| ||||
| Keywords: | STEM-CELL TRANSPLANTATION; IMMUNE DYSREGULATION; LRBA DEFICIENCY; CTLA-4 HAPLOINSUFFICIENCY; GERMLINE MUTATIONS; PATIENT; DISEASE; CLASSIFICATION; AUTOIMMUNITY; FAMILY; Cytotoxic T-lymphocyte antigen 4; primary immunodeficiency; autoimmunity; hypogammaglobulinemia; hematopoietic stem cell transplantation; abatacept; sirolimus; immune dysregulation; common variable immunodeficiency | ||||
| Dewey Decimal Classification: | 600 Technology > 610 Medical sciences Medicine | ||||
| Status: | Published | ||||
| Refereed: | Yes, this version has been refereed | ||||
| Created at the University of Regensburg: | Yes | ||||
| Item ID: | 46547 |
Abstract
Background: Cytotoxic T-lymphocyte antigen 4 (CTLA-4) is a negative immune regulator. Heterozygous CTLA4 germline mutations can cause a complex immune dysregulation syndrome in human subjects. Objective: We sought to characterize the penetrance, clinical features, and best treatment options in 133 CTLA4 mutation carriers. Methods: Genetics, clinical features, laboratory values, and outcomes of ...

Abstract
Background: Cytotoxic T-lymphocyte antigen 4 (CTLA-4) is a negative immune regulator. Heterozygous CTLA4 germline mutations can cause a complex immune dysregulation syndrome in human subjects. Objective: We sought to characterize the penetrance, clinical features, and best treatment options in 133 CTLA4 mutation carriers. Methods: Genetics, clinical features, laboratory values, and outcomes of treatment options were assessed in a worldwide cohort of CTLA4 mutation carriers. Results: We identified 133 subjects from 54 unrelated families carrying 45 different heterozygous CTLA4 mutations, including 28 previously undescribed mutations. Ninety mutation carriers were considered affected, suggesting a clinical penetrance of at least 67%; median age of onset was 11 years, and the mortality rate within affected mutation carriers was 16%(n = 15). Main clinical manifestations included hypogammaglobulinemia (84%), lymphoproliferation (73%), autoimmune cytopenia (62%), and respiratory (68%), gastrointestinal (59%), or neurological features (29%). Eight affectedmutation carriers had lymphoma, and 3 had gastric cancer. An EBV association was found in 6 patients with malignancies. CTLA4 mutations were associated with lymphopenia and decreased T-, B-, and natural killer (NK) cell counts. Successful targeted therapies included application of CTLA-4 fusion proteins, mechanistic target of rapamycin inhibitors, and hematopoietic stem cell transplantation. EBV reactivation occurred in 2 affected mutation carriers after immunosuppression. Conclusions: Affected mutation carriers with CTLA-4 insufficiency can present in any medical specialty. Family members should be counseled because disease manifestation can occur as late as 50 years of age. EBV- and cytomegalovirus-associated complications must be closely monitored. Treatment interventions should be coordinated in clinical trials.
Metadata last modified: 28 Jul 2021 16:54
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