[CIS PIDD] [cis-pidd] ADA2 deficiency?

Fri May 5 08:05:26 EDT 2017

Dear Beata,
the results of HSCT in ADA2 deficiency seem very good, as well as anti-TNF in vasculitis-like and disorders and stroke (which does not seem to be the main feature of your patient).
Did you have the plan to propose a HSCT for your patient ? What about possible donors ?
All the best
Elie

Elie Haddad, MD, PhD,
Professor of Pediatrics, University of Montreal,
Head, Pediatric Immunology and Rheumatology Division,
CHU Sainte-Justine, 3175 Cote Sainte-Catherine
Montreal, QC, H3T 1C5, Canada
Ph: 1 514 345 4713
fax: 1 514 345 4897
e-mail: elie.haddad at umontreal.ca

> Le 2017-05-04 à 08:00, CIS-PIDD <cis-pidd at lists.clinimmsoc.org> a écrit :
> 
> The patient developed a CVID-like clinical picture post RTX for her Evans-syndrome. She has been stable and doing very well on IVIG +MMF for many years. 
>  
> Beata
>  
> Beata Derfalvi  M.D., Ph.D.
> Pediatric Immunologist, Rheumatologist
> Associate Professor
> Dept. of Pediatrics, Dalhousie University/IWK Health Centre
> 5850 University Avenue
> Halifax, Nova Scotia B3K 6R8 CANADA
> ph 902-470-8481
> fax 902-470-7812
>  
> From: cis-pidd at lyris.dundee.net <mailto:cis-pidd at lyris.dundee.net> [mailto:cis-pidd at lyris.dundee.net <mailto:cis-pidd at lyris.dundee.net>] On Behalf Of CIS-PIDD
> Sent: Wednesday, May 03, 2017 4:32 PM
> To: CIS-PIDD
> Subject: RE: [cis-pidd] ADA2 deficiency?
>  
> I am a lab person. This is Dr. Derfalvi’s patient. She can answer your question.
> Thank you,
> Yenhui
>  
> From: cis-pidd at lyris.dundee.net <mailto:cis-pidd at lyris.dundee.net> [mailto:cis-pidd at lyris.dundee.net <mailto:cis-pidd at lyris.dundee.net>] On Behalf Of CIS-PIDD
> Sent: Wednesday, May 03, 2017 1:34 PM
> To: CIS-PIDD <cis-pidd at lyris.dundee.net <mailto:cis-pidd at lyris.dundee.net>>
> Subject: Re: [cis-pidd] ADA2 deficiency?
>  
> I agree it fits the genetic founds... please let us know the uptakes after treatment. Whats the plan?
> best 
>  
> leo
>  
> 2017-05-03 13:20 GMT-03:00 CIS-PIDD <cis-pidd at lists.clinimmsoc.org <mailto:cis-pidd at lists.clinimmsoc.org>>:
> Dear Dr. Kumar,
> Thank you very much for your feedback. Now I have more confidence in pursuing further confirmation and looking into similar cases.
> Warm regards,
> Yenhui
>  
> From: cis-pidd at lyris.dundee.net <mailto:cis-pidd at lyris.dundee.net> [mailto:cis-pidd at lyris.dundee.net <mailto:cis-pidd at lyris.dundee.net>] On Behalf Of CIS-PIDD
> Sent: Tuesday, May 02, 2017 8:42 PM
> To: CIS-PIDD <cis-pidd at lyris.dundee.net <mailto:cis-pidd at lyris.dundee.net>>
> Subject: Re: [cis-pidd] ADA2 deficiency?
>  
> The phenotype fits with DADA2, you're probably right.
> 
> Ashish  
> Ashish Kumar, MD, PhD 
> Associate Professor 
> Director, Pediatric Hematology-oncology fellowship program 
> Director, Langerhans cell histiocytosis center 
> Cincinnati Children's Hospital Medical Center 
> 
> On May 2, 2017, at 5:25 PM, CIS-PIDD <cis-pidd at lists.clinimmsoc.org <mailto:cis-pidd at lists.clinimmsoc.org>> wrote:
> 
> Dear All,
>  
> We tested a sample from a young girl with early-onset ITP and autoimmune hemolytic anemia with chronic splenomegaly and variable abdominal lymphadenopathy. The sample was sequenced with NGS technology using our 250 gene primary Immunodeficiency panel. A homologous insertion in exon 2 of CECR1 gene was identified. The variant Arg49Alafs*13 creates a frame shift starting at codon Arg49. The new reading frame ends in a stop codon 13 positions downstream.  The frequency of this variant is 0.024 in the general population. Her parents are first cousins, Middle-Eastern ethnicity.
>  
> Although ADA2 gene deficiency is characterized by various forms of auto inflammatory vasculitis it has a highly variable clinical expression.  Two cases with the same Arg49Alafs*13 variant and similar clinical expression with our patient were described in a recent paper by Dr. Polina Stepensky et al (J Pediatr 2016;177:316-2).  My understanding is that these two cases were both tested as ADA2 low activity by Dr. Hershfield’s group in Duke.
>  
> I strongly feel the variant Arg49Alafs*13 is accountable for this girl’s disease. If it is confirmed, she may get corresponding treatment. Please let me know your thoughts.
>  
> Thank you for your time and input.
> Yenhui
>  
> Yenhui Chang, PhD
> Immunogenetics
> Johns Hopkins All Children’s Hospital
> St. Petersburg, FL
>  
>  
>  
>  
> 
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> -- 
>  
> Leonardo Oliveira Mendonça
> Médico Especialista em Imunologia Clínica e Alergia, Doenças Autoimunes e Autoinflamatórias
> Médico Especialista em Clínica Médica/Medicina Interna
>  
> Leonardo Oliveira Mendonça, MD
> Specialist in Clinical Immunology and Allergy, Autoimmune and Autoinflammatory disorders
> Consultant Specialist in Internal Medicine
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