Refine
Has Fulltext
- yes (3)
Is part of the Bibliography
- yes (3)
Document Type
- Journal article (2)
- Doctoral Thesis (1)
Language
- English (3)
Keywords
- CVID (2)
- Escherichia coli (1)
- European Society for Immunodeficiencies (ESID) (1)
- Gene regulation (1)
- Genregulation (1)
- German PID-NET registry (1)
- H-NS (1)
- Histon-ähnliche Proteine (1)
- Histone-like proteins (1)
- IgG substitution therapy (1)
Introduction: The German PID-NET registry was founded in 2009, serving as the first national registry of patients with primary immunodeficiencies (PID) in Germany. It is part of the European Society for Immunodeficiencies (ESID) registry. The primary purpose of the registry is to gather data on the epidemiology, diagnostic delay, diagnosis, and treatment of PIDs.
Methods: Clinical and laboratory data was collected from 2,453 patients from 36 German PID centres in an online registry. Data was analysed with the software Stata® and Excel.
Results: The minimum prevalence of PID in Germany is 2.72 per 100,000 inhabitants. Among patients aged 1-25, there was a clear predominance of males. The median age of living patients ranged between 7 and 40 years, depending on the respective PID. Predominantly antibody disorders were the most prevalent group with 57% of all 2,453 PID patients (including 728 CVID patients). A gene defect was identified in 36% of patients. Familial cases were observed in 21% of patients. The age of onset for presenting symptoms ranged from birth to late adulthood (range 0-88 years). Presenting symptoms comprised infections (74%) and immune dysregulation (22%). Ninety-three patients were diagnosed without prior clinical symptoms. Regarding the general and clinical diagnostic delay, no PID had undergone a slight decrease within the last decade. However, both, SCID and hyper IgE-syndrome showed a substantial improvement in shortening the time between onset of symptoms and genetic diagnosis. Regarding treatment, 49% of all patients received immunoglobulin G (IgG) substitution (70%-subcutaneous; 29%-intravenous; 1%-unknown). Three-hundred patients underwent at least one hematopoietic stem cell transplantation (HSCT). Five patients had gene therapy.
Conclusion: The German PID-NET registry is a precious tool for physicians, researchers, the pharmaceutical industry, politicians, and ultimately the patients, for whom the outcomes will eventually lead to a more timely diagnosis and better treatment.
In this study, the role of histone-like proteins in gene regulation in uropathogenic Escherichia coli isolate 536 was monitored. The histone-like nucleoid structuring protein H-NS is a global regulator in Escherichia coli that has been intensively studied in non-pathogenic strains. No comprehensive study on the role of H-NS and it’s homolog StpA on gene expression in a pathogenic E. coli strain has been carried out so far. Moreover, we identified a third, so far uncharacterized member of the H-NS-like protein family in uropathogenic E. coli isolate 536, which was designated Hlp (H-NS-like protein). Hlp is a 134-amino acid protein, which shares 58 % sequence identity with H-NS. The gene coding for the Hlp protein, hlp, is found in several uropathogenic E. coli variants, but not in non-pathogenic E. coli K-12. In UPEC strains 536 and CFT073, Hlp is encoded on a possibly horizontally acquired 23-kb genomic region inserted into the serU locus. Studies on hlp transcription revealed, that the gene is transcribed monocistronically from a single promoter and that expression is repressed by H-NS. Purified Hlp protein was binding to its own and to the hns promoter, thereby mediating negative auto- and crossregulation. Furthermore, Hlp and H-NS were directly interacting, resulting in the formation of stable heteromers. Complementation studies with hns mutant strains in a K-12 background revealed that the Hlp protein had in vivo activity, being able to complement the lack of H-NS in terms of motility, growth, and repression of the proU, bgl, and clyA genes. When analyzing the role of the histone-like proteins in expression of virulence-associated genes by using DNA arrays and classical phenotypic assays, most of the observed effects were mediated by the H-NS protein alone. Expression profiling revealed that transcript level of more than 500 genes was affected by an hns mutation, resulting in increased expression of alpha-hemolysin, fimbriae and iron-uptake systems, as well as genes involved in stress adaptation. Furthermore, several other putative virulence factors were found to be part of the H-NS regulon. On the other hand, no effect of StpA alone was observed. An hns stpA double mutant, however, exhibited a distinct gene expression pattern that differed in great parts from that of the hns single mutant. This suggests a direct interaction between the two homologs and the existence of distinct regulons of H-NS and an H-NS/StpA heteromeric complex. Although the H-NS protein has – either as homomer or in complex with StpA – a marked impact on gene expression in pathogenic E. coli strains, its effect on urovirulence is ambiguous. At a high infection dose, hns mutants accelerate lethality in murine UTI and sepsis models relative to the wild type, probably due to increased production of alpha-hemolysin. At lower infectious dose, however, mutants lacking H-NS are attenuated through their impaired growth rate, which can only partially be compensated by the higher expression of numerous virulence factors. As seen with StpA, an hlp single mutant did not exhibit a notable phenotype under standard growth conditions. A severe growth defect of hns hlp double mutants at low temperatures, however, suggests a biological relevance of H-NS/Hlp heteromers under certain circumstances. Furthermore, these mutants expressed more capsular polysaccharide and curli fimbriae, thereby indicating a distinct role of H-NS and Hlp in regulation of these surface structures. The H-NS paralogs Hlp and StpA also modulated H-NS-mediated regulation of fimbrial adhesins, and are oppositely required for normal growth at low or high temperatures, respectively. Finally, expression levels of the three histone-like proteins H-NS, StpA and Hlp itself varied with different temperatures, thereby suggesting a flexible composition of the nucleoid-associated protein pool. Hence, we propose that the biological role of Hlp and StpA does not rely on a distinct function of the single protein, but rather on their interaction with the global regulator H-NS.
This evidence‐based clinical guideline provides consensus‐recommendations for the treatment and care of patients with primary antibody deficiencies (PADs). The guideline group comprised 20 clinical and scientific expert associations of the German, Swiss, and Austrian healthcare system and representatives of patients. Recommendations were based on results of a systematic literature search, data extraction, and evaluation of methodology and study quality in combination with the clinical expertise of the respective representatives. Consensus‐based recommendations were determined via nominal group technique. PADs are the largest clinically relevant group of primary immunodeficiencies. Most patients with PADs present with increased susceptibility to infections, however immune dysregulation, autoimmunity, and cancer affect a significant number of patients and may precede infections. This guideline therefore covers interdisciplinary clinical and therapeutic aspects of infectious (e.g., antibiotic prophylaxis, management of bronchiectasis) and non‐infectious manifestations (e.g., management of granulomatous disease, immune cytopenia). PADs are grouped into disease entities with definitive, probable, possible, or unlikely benefit of IgG‐replacement therapy. Summary and consensus‐recommendations are provided for treatment indication, dosing, routes of administration, and adverse events of IgG‐replacement therapy. Special aspects of concomitant impaired T‐cell function are highlighted as well as clinical data on selected monogenetic inborn errors of immunity formerly classified into PADs (APDS, CTLA‐4‐, and LRBA‐deficiency).