Immunologic features of Cornelia de Lange syndrome

• Published in: Pediatrics (Evanston) Vol. 132; no. 2; p. e484
• Main Authors: Jyonouchi, Soma, Orange, Jordan, Sullivan, Kathleen E, Krantz, Ian, Deardorff, Matthew
• Format: Journal Article
• Language: English
• Published: United States 01.08.2013
• Subjects: Adolescent; Adult; Cell Cycle Proteins - genetics; Child; Child, Preschool; Chromosomal Proteins, Non-Histone - genetics; Cohesins; Cross-Sectional Studies; Cytokines - blood; De Lange Syndrome - diagnosis; De Lange Syndrome - epidemiology; De Lange Syndrome - genetics; De Lange Syndrome - immunology; DNA Mutational Analysis; Female; Humans; Immunologic Deficiency Syndromes - diagnosis; Immunologic Deficiency Syndromes - epidemiology; Immunologic Deficiency Syndromes - genetics; Immunologic Deficiency Syndromes - immunology; Immunologic Tests; Infant; Lymphocyte Activation - genetics; Lymphocyte Activation - immunology; Male; NFATC Transcription Factors - genetics; Opportunistic Infections - diagnosis; Opportunistic Infections - epidemiology; Opportunistic Infections - genetics; Opportunistic Infections - immunology; Philadelphia; Recurrence; RNA, Messenger - genetics; T-Lymphocyte Subsets - immunology; Young Adult; Philadelphia; Cornelia de Lange syndrome; immunodeficiency; antibody; cohesin
• ISSN: 1098-4275
• DOI: 10.1542/peds.2012-3815

Cornelia de Lange syndrome (CdLS) is a genetic syndrome with multisystem abnormalities. Infections are a significant cause of morbidity and mortality. The goals of our study were to identify the frequency and types of infections in CdLS and to determine if underlying immunodeficiency contributes to the clinical spectrum of this syndrome. We assessed infectious histories in 45 patients with CdLS and evaluated conventional immunologic screening tests in 27 patients. Among these 27 subjects, additional phenotypic enumeration of T-cell subsets, expression of activation markers in T cells, and production of cytokines in response to T-cell stimulants were studied in 12 CdLS subjects compared with 12 normal case control subjects. Recurrent infections were reported at high frequency in CdLS patients and included chronic ear infections (53%), chronic viral respiratory infections (46%), pneumonia (42%), sinus infections (33%), oral candidiasis (13%), sepsis (6%), and bacterial skin infections (4%). Full immune evaluation in 27 subjects led to identification of 9 cases of antibody deficiency syndrome in patients with severe forms of CdLS. Subjects with CdLS had decreased percentages of T regulatory cells and T follicular helper cells compared with normal control subjects (P < .05). This study identified for the first time a high frequency of antibody deficiency in CdLS subjects, indicating a critical need for screening and management of immunodeficiency in CdLS patients with a history of well-documented severe or recurrent infections. Furthermore, our results indicate that impaired T-cell populations may be associated with antibody deficiency in CdLS.