A novel splice variant of FcγRIIa: A risk factor for anaphylaxis in patients with hypogammaglobulinemia
Our index case was a patient with common variable immunodeficiency (CVID). She had anaphylactoid reactions on administration of intravenous immunoglobulin (IVIg) associated with the presence of IgG antibodies against IgA. We sought to determine the role of Fcγ receptor (FcγR) IIa in IVIg-induced ana...
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Published in | Journal of allergy and clinical immunology Vol. 131; no. 5; pp. 1408 - 1416.e5 |
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Main Authors | , , , , , , , , |
Format | Journal Article |
Language | English |
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Mosby, Inc
01.05.2013
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Abstract | Our index case was a patient with common variable immunodeficiency (CVID). She had anaphylactoid reactions on administration of intravenous immunoglobulin (IVIg) associated with the presence of IgG antibodies against IgA.
We sought to determine the role of Fcγ receptor (FcγR) IIa in IVIg-induced anaphylactoid reactions.
Neutrophils and PBMCs were isolated from healthy subjects and IVIg-treated patients. FcγRIIa mRNA and DNA were analyzed by using real-time PCR and sequencing. IgG-mediated elastase release and intracellular Ca2+ mobilization were determined in neutrophils and transfected cell lines, respectively.
A novel splice variant of FcγRIIa containing an expressed cryptic exon 6* (FcγRIIaexon6∗) was identified in our index patient. This exon is normally spliced out of all FcγRII isoforms, except the inhibitory FcγRIIb1. Compared with healthy control subjects, the heterozygous FCGR2Ac.742+871A>G mutation was more frequent in patients with CVID (n = 53, P < .013). Expression in patients with CVID was associated with anaphylaxis on IVIg infusion (P = .002). On screening of additional IVIg-treated patient cohorts, we identified 6 FCGR2Ac.742+871A>G allele–positive patients with Kawasaki disease (n = 208) and 1 patient with idiopathic thrombocytopenia (n = 93). None had adverse reactions to IVIg. Moreover, FcγRIIaexon6∗ was also demonstrated in asymptomatic family members. Functional studies in primary cells and transfected murine cells demonstrated enhanced cellular activation by FcγRIIaexon6∗ compared with its native form, as shown by increased elastase release and intracellular calcium mobilization.
A novel splice variant, FcγRIIaexon6∗, was characterized as a low-frequency allele, coding for a gain-of-function receptor for IgG. In the presence of immune complexes, FcγRIIaexon6∗ can contribute to anaphylaxis in patients with CVID. |
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AbstractList | Background Our index case was a patient with common variable immunodeficiency (CVID). She had anaphylactoid reactions on administration of intravenous immunoglobulin (IVIg) associated with the presence of IgG antibodies against IgA. Objective We sought to determine the role of Fcγ receptor (FcγR) IIa in IVIg-induced anaphylactoid reactions. Methods Neutrophils and PBMCs were isolated from healthy subjects and IVIg-treated patients. FcγRIIa mRNA and DNA were analyzed by using real-time PCR and sequencing. IgG-mediated elastase release and intracellular Ca2+ mobilization were determined in neutrophils and transfected cell lines, respectively. Results A novel splice variant of FcγRIIa containing an expressed cryptic exon 6* (FcγRIIaexon6∗ ) was identified in our index patient. This exon is normally spliced out of all FcγRII isoforms, except the inhibitory FcγRIIb1. Compared with healthy control subjects, the heterozygous FCGR2Ac.742+871A>G mutation was more frequent in patients with CVID (n = 53, P < .013). Expression in patients with CVID was associated with anaphylaxis on IVIg infusion ( P = .002). On screening of additional IVIg-treated patient cohorts, we identified 6 FCGR2Ac.742+871A>G allele–positive patients with Kawasaki disease (n = 208) and 1 patient with idiopathic thrombocytopenia (n = 93). None had adverse reactions to IVIg. Moreover, FcγRIIaexon6∗ was also demonstrated in asymptomatic family members. Functional studies in primary cells and transfected murine cells demonstrated enhanced cellular activation by FcγRIIaexon6∗ compared with its native form, as shown by increased elastase release and intracellular calcium mobilization. Conclusion A novel splice variant, FcγRIIaexon6∗ , was characterized as a low-frequency allele, coding for a gain-of-function receptor for IgG. In the presence of immune complexes, FcγRIIaexon6∗ can contribute to anaphylaxis in patients with CVID. Our index case was a patient with common variable immunodeficiency (CVID). She had anaphylactoid reactions on administration of intravenous immunoglobulin (IVIg) associated with the presence of IgG antibodies against IgA. We sought to determine the role of Fcγ receptor (FcγR) IIa in IVIg-induced anaphylactoid reactions. Neutrophils and PBMCs were isolated from healthy subjects and IVIg-treated patients. FcγRIIa mRNA and DNA were analyzed by using real-time PCR and sequencing. IgG-mediated elastase release and intracellular Ca2+ mobilization were determined in neutrophils and transfected cell lines, respectively. A novel splice variant of FcγRIIa containing an expressed cryptic exon 6* (FcγRIIaexon6∗) was identified in our index patient. This exon is normally spliced out of all FcγRII isoforms, except the inhibitory FcγRIIb1. Compared with healthy control subjects, the heterozygous FCGR2Ac.742+871A>G mutation was more frequent in patients with CVID (n = 53, P < .013). Expression in patients with CVID was associated with anaphylaxis on IVIg infusion (P = .002). On screening of additional IVIg-treated patient cohorts, we identified 6 FCGR2Ac.742+871A>G allele–positive patients with Kawasaki disease (n = 208) and 1 patient with idiopathic thrombocytopenia (n = 93). None had adverse reactions to IVIg. Moreover, FcγRIIaexon6∗ was also demonstrated in asymptomatic family members. Functional studies in primary cells and transfected murine cells demonstrated enhanced cellular activation by FcγRIIaexon6∗ compared with its native form, as shown by increased elastase release and intracellular calcium mobilization. A novel splice variant, FcγRIIaexon6∗, was characterized as a low-frequency allele, coding for a gain-of-function receptor for IgG. In the presence of immune complexes, FcγRIIaexon6∗ can contribute to anaphylaxis in patients with CVID. Our index case was a patient with common variable immunodeficiency (CVID). She had anaphylactoid reactions on administration of intravenous immunoglobulin (IVIg) associated with the presence of IgG antibodies against IgA.BACKGROUNDOur index case was a patient with common variable immunodeficiency (CVID). She had anaphylactoid reactions on administration of intravenous immunoglobulin (IVIg) associated with the presence of IgG antibodies against IgA.We sought to determine the role of Fcγ receptor (FcγR) IIa in IVIg-induced anaphylactoid reactions.OBJECTIVEWe sought to determine the role of Fcγ receptor (FcγR) IIa in IVIg-induced anaphylactoid reactions.Neutrophils and PBMCs were isolated from healthy subjects and IVIg-treated patients. FcγRIIa mRNA and DNA were analyzed by using real-time PCR and sequencing. IgG-mediated elastase release and intracellular Ca(2+) mobilization were determined in neutrophils and transfected cell lines, respectively.METHODSNeutrophils and PBMCs were isolated from healthy subjects and IVIg-treated patients. FcγRIIa mRNA and DNA were analyzed by using real-time PCR and sequencing. IgG-mediated elastase release and intracellular Ca(2+) mobilization were determined in neutrophils and transfected cell lines, respectively.A novel splice variant of FcγRIIa containing an expressed cryptic exon 6* (FcγRIIa(exon6∗)) was identified in our index patient. This exon is normally spliced out of all FcγRII isoforms, except the inhibitory FcγRIIb1. Compared with healthy control subjects, the heterozygous FCGR2A(c.742+871A>G) mutation was more frequent in patients with CVID (n = 53, P < .013). Expression in patients with CVID was associated with anaphylaxis on IVIg infusion (P = .002). On screening of additional IVIg-treated patient cohorts, we identified 6 FCGR2A(c.742+871A>G) allele-positive patients with Kawasaki disease (n = 208) and 1 patient with idiopathic thrombocytopenia (n = 93). None had adverse reactions to IVIg. Moreover, FcγRIIa(exon6∗) was also demonstrated in asymptomatic family members. Functional studies in primary cells and transfected murine cells demonstrated enhanced cellular activation by FcγRIIa(exon6∗) compared with its native form, as shown by increased elastase release and intracellular calcium mobilization.RESULTSA novel splice variant of FcγRIIa containing an expressed cryptic exon 6* (FcγRIIa(exon6∗)) was identified in our index patient. This exon is normally spliced out of all FcγRII isoforms, except the inhibitory FcγRIIb1. Compared with healthy control subjects, the heterozygous FCGR2A(c.742+871A>G) mutation was more frequent in patients with CVID (n = 53, P < .013). Expression in patients with CVID was associated with anaphylaxis on IVIg infusion (P = .002). On screening of additional IVIg-treated patient cohorts, we identified 6 FCGR2A(c.742+871A>G) allele-positive patients with Kawasaki disease (n = 208) and 1 patient with idiopathic thrombocytopenia (n = 93). None had adverse reactions to IVIg. Moreover, FcγRIIa(exon6∗) was also demonstrated in asymptomatic family members. Functional studies in primary cells and transfected murine cells demonstrated enhanced cellular activation by FcγRIIa(exon6∗) compared with its native form, as shown by increased elastase release and intracellular calcium mobilization.A novel splice variant, FcγRIIa(exon6∗), was characterized as a low-frequency allele, coding for a gain-of-function receptor for IgG. In the presence of immune complexes, FcγRIIa(exon6∗) can contribute to anaphylaxis in patients with CVID.CONCLUSIONA novel splice variant, FcγRIIa(exon6∗), was characterized as a low-frequency allele, coding for a gain-of-function receptor for IgG. In the presence of immune complexes, FcγRIIa(exon6∗) can contribute to anaphylaxis in patients with CVID. Our index case was a patient with common variable immunodeficiency (CVID). She had anaphylactoid reactions on administration of intravenous immunoglobulin (IVIg) associated with the presence of IgG antibodies against IgA. We sought to determine the role of Fcγ receptor (FcγR) IIa in IVIg-induced anaphylactoid reactions. Neutrophils and PBMCs were isolated from healthy subjects and IVIg-treated patients. FcγRIIa mRNA and DNA were analyzed by using real-time PCR and sequencing. IgG-mediated elastase release and intracellular Ca(2+) mobilization were determined in neutrophils and transfected cell lines, respectively. A novel splice variant of FcγRIIa containing an expressed cryptic exon 6* (FcγRIIa(exon6∗)) was identified in our index patient. This exon is normally spliced out of all FcγRII isoforms, except the inhibitory FcγRIIb1. Compared with healthy control subjects, the heterozygous FCGR2A(c.742+871A>G) mutation was more frequent in patients with CVID (n = 53, P < .013). Expression in patients with CVID was associated with anaphylaxis on IVIg infusion (P = .002). On screening of additional IVIg-treated patient cohorts, we identified 6 FCGR2A(c.742+871A>G) allele-positive patients with Kawasaki disease (n = 208) and 1 patient with idiopathic thrombocytopenia (n = 93). None had adverse reactions to IVIg. Moreover, FcγRIIa(exon6∗) was also demonstrated in asymptomatic family members. Functional studies in primary cells and transfected murine cells demonstrated enhanced cellular activation by FcγRIIa(exon6∗) compared with its native form, as shown by increased elastase release and intracellular calcium mobilization. A novel splice variant, FcγRIIa(exon6∗), was characterized as a low-frequency allele, coding for a gain-of-function receptor for IgG. In the presence of immune complexes, FcγRIIa(exon6∗) can contribute to anaphylaxis in patients with CVID. BACKGROUND: Our index case was a patient with common variable immunodeficiency (CVID). She had anaphylactoid reactions on administration of intravenous immunoglobulin (IVIg) associated with the presence of IgG antibodies against IgA. OBJECTIVE: We sought to determine the role of Fcγ receptor (FcγR) IIa in IVIg-induced anaphylactoid reactions. METHODS: Neutrophils and PBMCs were isolated from healthy subjects and IVIg-treated patients. FcγRIIa mRNA and DNA were analyzed by using real-time PCR and sequencing. IgG-mediated elastase release and intracellular Ca²⁺ mobilization were determined in neutrophils and transfected cell lines, respectively. RESULTS: A novel splice variant of FcγRIIa containing an expressed cryptic exon 6* (FcγRIIaᵉˣᵒⁿ⁶∗) was identified in our index patient. This exon is normally spliced out of all FcγRII isoforms, except the inhibitory FcγRIIb1. Compared with healthy control subjects, the heterozygous FCGR2Aᶜ.⁷⁴²⁺⁸⁷¹ᴬ>ᴳ mutation was more frequent in patients with CVID (n = 53, P < .013). Expression in patients with CVID was associated with anaphylaxis on IVIg infusion (P = .002). On screening of additional IVIg-treated patient cohorts, we identified 6 FCGR2Aᶜ.⁷⁴²⁺⁸⁷¹ᴬ>ᴳ allele–positive patients with Kawasaki disease (n = 208) and 1 patient with idiopathic thrombocytopenia (n = 93). None had adverse reactions to IVIg. Moreover, FcγRIIaᵉˣᵒⁿ⁶∗ was also demonstrated in asymptomatic family members. Functional studies in primary cells and transfected murine cells demonstrated enhanced cellular activation by FcγRIIaᵉˣᵒⁿ⁶∗ compared with its native form, as shown by increased elastase release and intracellular calcium mobilization. CONCLUSION: A novel splice variant, FcγRIIaᵉˣᵒⁿ⁶∗, was characterized as a low-frequency allele, coding for a gain-of-function receptor for IgG. In the presence of immune complexes, FcγRIIaᵉˣᵒⁿ⁶∗ can contribute to anaphylaxis in patients with CVID. |
Author | Geissler, Judy van Deuren, Marcel van den Berg, Timo K. van der Heijden, Joris van der Meer, Jos W.M. Kuijpers, Taco W. Roos, Dirk van Mirre, Edwin Salama, Abdulgabar |
Author_xml | – sequence: 1 givenname: Joris surname: van der Heijden fullname: van der Heijden, Joris organization: Department of Blood Cell Research, Sanquin Research at CLB and Landsteiner Laboratory, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands – sequence: 2 givenname: Judy surname: Geissler fullname: Geissler, Judy organization: Department of Blood Cell Research, Sanquin Research at CLB and Landsteiner Laboratory, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands – sequence: 3 givenname: Edwin surname: van Mirre fullname: van Mirre, Edwin organization: Department of Blood Cell Research, Sanquin Research at CLB and Landsteiner Laboratory, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands – sequence: 4 givenname: Marcel surname: van Deuren fullname: van Deuren, Marcel organization: Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands – sequence: 5 givenname: Jos W.M. surname: van der Meer fullname: van der Meer, Jos W.M. organization: Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands – sequence: 6 givenname: Abdulgabar surname: Salama fullname: Salama, Abdulgabar organization: Universitätsklinikum Charité, Institut für Transfusionsmedizin, Campus Virchow-Klinikum, Berlin, Germany – sequence: 7 givenname: Timo K. surname: van den Berg fullname: van den Berg, Timo K. organization: Department of Blood Cell Research, Sanquin Research at CLB and Landsteiner Laboratory, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands – sequence: 8 givenname: Dirk surname: Roos fullname: Roos, Dirk organization: Department of Blood Cell Research, Sanquin Research at CLB and Landsteiner Laboratory, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands – sequence: 9 givenname: Taco W. surname: Kuijpers fullname: Kuijpers, Taco W. email: t.w.kuijpers@amc.nl organization: Department of Blood Cell Research, Sanquin Research at CLB and Landsteiner Laboratory, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/23545275$$D View this record in MEDLINE/PubMed |
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Copyright | 2013 American Academy of Allergy, Asthma & Immunology American Academy of Allergy, Asthma & Immunology Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved. |
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Keywords | IMIg Fcγ receptors [Ca2+]i fMLP ITP IVIg common variable immunodeficiency elastase CVID FITC Anaphylaxis Kawasaki disease SNP KD intravenous immunoglobulin splice variant neutrophils FcγR idiopathic thrombocytopenia Fluorescein isothiocyanate N-formyl-methionyl-leucyl-phenylalanine Fcγ receptor [Ca 2+] i Intramuscular immunoglobulin Single nucleotide polymorphism Intracellular Ca 2+ ions |
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Snippet | Our index case was a patient with common variable immunodeficiency (CVID). She had anaphylactoid reactions on administration of intravenous immunoglobulin... Background Our index case was a patient with common variable immunodeficiency (CVID). She had anaphylactoid reactions on administration of intravenous... Our index case was a patient with common variable immunodeficiency (CVID). She had anaphylactoid reactions on administration of intravenous immunoglobulin... BACKGROUND: Our index case was a patient with common variable immunodeficiency (CVID). She had anaphylactoid reactions on administration of intravenous... |
SourceID | proquest pubmed crossref elsevier |
SourceType | Aggregation Database Index Database Enrichment Source Publisher |
StartPage | 1408 |
SubjectTerms | Adult adverse effects Agammaglobulinemia - etiology Agammaglobulinemia - genetics Agammaglobulinemia - immunology alleles Allergy and Immunology Anaphylaxis Anaphylaxis - complications Anaphylaxis - genetics Anaphylaxis - immunology Animals antibodies antigen-antibody complex calcium common variable immunodeficiency DNA elastase exons Fcγ receptors Female heterozygosity Humans idiopathic thrombocytopenia immunoglobulin A immunoglobulin G immunosuppression intravenous immunoglobulin intravenous injection Kawasaki disease Male messenger RNA Mice mononuclear leukocytes mutation neutrophils Neutrophils - immunology Neutrophils - pathology patients Protein Isoforms - immunology quantitative polymerase chain reaction Receptors, IgG - genetics Risk Factors screening splice variant thrombocytopenia |
Title | A novel splice variant of FcγRIIa: A risk factor for anaphylaxis in patients with hypogammaglobulinemia |
URI | https://www.clinicalkey.com/#!/content/1-s2.0-S0091674913003151 https://www.clinicalkey.es/playcontent/1-s2.0-S0091674913003151 https://dx.doi.org/10.1016/j.jaci.2013.02.009 https://www.ncbi.nlm.nih.gov/pubmed/23545275 https://www.proquest.com/docview/1347256957 https://www.proquest.com/docview/1746447704 |
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