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Phenotype, penetrance, and treatment of 133 cytotoxic T-lymphocyte antigen 4-insufficient subjects

C. Schwab, A. Gabrysch, P. Olbrich, V. Patiño, K. Warnatz, D. Wolff, A. Hoshino, M. Kobayashi, K. Imai, M. Takagi, I. Dybedal, JA. Haddock, DM. Sansom, JM. Lucena, M. Seidl, A. Schmitt-Graeff, V. Reiser, F. Emmerich, N. Frede, A. Bulashevska, U....

. 2018 ; 142 (6) : 1932-1946. [pub] 20180504

Jazyk angličtina Země Spojené státy americké

Typ dokumentu časopisecké články, práce podpořená grantem

Perzistentní odkaz   https://www.medvik.cz/link/bmc19035267

Grantová podpora
R01 AI085090 NIAID NIH HHS - United States
R34 AI106570 NIAID NIH HHS - United States
BB/H013598/1 Biotechnology and Biological Sciences Research Council - United Kingdom
K08 CA219473 NCI NIH HHS - United States
P01 AI061093 NIAID NIH HHS - United States
NV15-30626A MZ0 CEP - Centrální evidence projektů

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 affected mutation 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.

Allergy and Clinical Immunology Department Functional Unit of Immunology SJD Clinic Hospital Sant Joan de Déu Institut de Recerca Pediàtrica Hospital Sant Joan de Déu Esplugues de Llobregat Spain

Center for Chronic Immunodeficiency and Molecular Pathology Department of Pathology University Medical Center University of Freiburg Freiburg Germany

Center for Chronic Immunodeficiency Medical Center University of Freiburg Faculty of Medicine University of Freiburg Freiburg Germany

Center for Pediatrics University Medical Center Faculty of Medicine University of Freiburg Freiburg Germany

Center of Pediatric Surgery Hannover Medical School Hannover Germany

Centre for Molecular Medicine Norway Nordic EMBL Partnership University of Oslo and Institute for Cancer Research University Hospital Oslo Oslo Norway

Children's Hospital of Philadelphia Perelman School of Medicine University of Pennsylvania Philadelphia Pa

Clinical Immunology and Allergy Unit Nottingham University Hospitals Nottingham United Kingdom

CLIP Department of Paediatric Haematology Oncology 2nd Faculty of Medicine Charles University and University Hospital Motol Prague Czech Republic

Department of Clinical Immunology and Allergology Medical Faculty Masaryk University Brno Czech Republic

Department of Clinical Immunology and Allergology St Anne's University Hospital Brno Czech Republic

Department of Clinical Immunology and Allergy Royal Melbourne Hospital Melbourne Australia

Department of Community Pediatrics Perinatal and Maternal Medicine Tokyo Medical and Dental University Tokyo Japan

Department of Hematology Oslo University Hospital Oslo Norway

Department of Immunology and Histocompatibility Centre for Primary Immunodeficiencies Aghia Sophia Children's Hospital Athens Greece

Department of Immunology University Hospital Motol and 2nd Faculty of Medicine Charles University Prague Prague Czech Republic

Department of Immunology University Hospital Zurich University of Zurich Zurich Switzerland

Department of Infectious Diseases and General Internal Medicine University Hospital of Liège Liege Belgium

Department of Internal Medicine 1 University Medical Center Schleswig Holstein Kiel Germany

Department of Internal Medicine 3 University Hospital Regensburg Regensburg Germany

Department of Internal Medicine Radboudumc Center for Infectious Diseases Nijmegen The Netherlands

Department of Medicine 1 University Medical Center Dresden Technical University Dresden Dresden Germany

Department of Medicine Clinical Immunology and Allergy Division Centre Hospitalier de l'Université de Montréal Université de Montréal Montreal Quebec Canada

Department of Paediatric Gastroenterology Great North Children's Hospital Newcastle United Kingdom

Department of Pathology University Medical Center University of Freiburg Freiburg Germany

Department of Pediatric Immunology and Stem Cell Transplantation Dr von Hauner Children's Hospital Ludwig Maximilians Universität Munich Germany

Department of Pediatric Pneumology Allergy and Neonatology Hannover Medical School Hannover Germany

Department of Pediatrics and Developmental Biology Graduate School of Medical and Dental Sciences Tokyo Medical and Dental University Tokyo Japan

Department of Pediatrics Division of Pediatric Hematology Oncology Weill Cornell Medicine New York NY

Department of Pediatrics Hiroshima University Graduate School of Biomedical and Health Sciences Hiroshima Japan

Department of Pediatrics University Hospital Jena Jena Germany

Department of Pediatrics University Hospital Motol and 2nd Faculty of Medicine Charles University Prague Prague Czech Republic

Department of Pediatrics University Medical Center Ulm Ulm Germany

Department of Radiology Royal Free Hospital University College London London United Kingdom

Division of Bone Marrow Transplantation and Immune Deficiency Cincinnati Children's Hospital Medical Center Cincinnati Ohio

Division of Gastroenterology and Department of Pediatrics Harvard Medical School Boston Mass

Division of Gastroenterology Hepatology and Endoscopy Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston Mass

Division of Immunology Boston Children's Hospital and Department of Pediatrics Harvard Medical School Boston Mass

Division of Immunology University Children's Hospital Zurich University of Zurich Zurich Switzerland

Division of Pediatric Gastroenterology Hepatology and Nutrition Department of Medicine Children's Hospital Boston Mass

Division of Rheumatology Department of Internal Medicine 5 University of Heidelberg Heidelberg Germany

Great North Children's Hospital Newcastle upon Tyne Hospitals NHS Foundation Trust and Institute of Cellular Medicine Newcastle University Newcastle United Kingdom

HELIOS Children's Hospital Krefeld Germany

Immunodeficiency Clinic Medical Outpatient Unit and Immunodeficiency Lab Department Biomedicine University Hospital Basel Switzerland

Immunology Team American Insurance Montevideo Uruguay

Institute for Computational Biomedicine Department of Physiology and Biophysics Weill Cornell Medical College New York NY

Institute for Transfusion Medicine and Gene Therapy University Medical Center Freiburg Freiburg Germany

Institute of Clinical Molecular Biology Christian Albrechts University of Kiel Kiel Germany

Institute of Immunology and Transplantation Royal Free Hospital University College London London United Kingdom

Institute of Immunology University Hospital Heidelberg Heidelberg Germany

Institute of Medical Biometry and Statistics Faculty of Medicine and Medical Center University of Freiburg Freiburg Germany

Medical Genomics RG Central European Institute of Technology Masaryk University Brno Czech Republic

Molecular Genetics Laboratory Centre for Cardiovascular Surgery and Transplantation Brno Czech Republic

Mount Sinai Hospital Mount Sinai St Luke's and Mount Sinai West Department of Medicine Allergy and Immunology New York NY

Pediatrics Clinic and Institute for Molecular Medicine A Nocivelli Department of Clinical and Experimental Sciences University of Brescia ASST Spedali Civili of Brescia Brescia Italy

Sección de Infectología e Inmunopatología Unidad de Pediatría Hospital Virgen del Rocío Instituto de Biomedicina de Sevilla Seville Spain

Section of Allergy and Clinical Immunology Yale University School of Medicine New Haven Conn

Servei de Genòmica Departament de Ciències Experimentals i de la Salut Universitat Pompeu Fabra Parc de Recerca Biomèdica de Barcelona Barcelona Spain

Spemann Graduate School of Biology and Medicine Freiburg University Freiburg Germany

UCL Institute of Immunity and Transplantation Royal Free Hospital London United Kingdom

Unidad de Inmunología Hospital Universitario Virgen del Rocío Instituto de Biomedicina de Sevilla Seville Spain

University of Manchester Royal Manchester Children's Hospital Manchester United Kingdom

Citace poskytuje Crossref.org

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$a Phenotype, penetrance, and treatment of 133 cytotoxic T-lymphocyte antigen 4-insufficient subjects / $c C. Schwab, A. Gabrysch, P. Olbrich, V. Patiño, K. Warnatz, D. Wolff, A. Hoshino, M. Kobayashi, K. Imai, M. Takagi, I. Dybedal, JA. Haddock, DM. Sansom, JM. Lucena, M. Seidl, A. Schmitt-Graeff, V. Reiser, F. Emmerich, N. Frede, A. Bulashevska, U. Salzer, D. Schubert, S. Hayakawa, S. Okada, M. Kanariou, ZY. Kucuk, H. Chapdelaine, L. Petruzelkova, Z. Sumnik, A. Sediva, M. Slatter, PD. Arkwright, A. Cant, HM. Lorenz, T. Giese, V. Lougaris, A. Plebani, C. Price, KE. Sullivan, M. Moutschen, J. Litzman, T. Freiberger, FL. van de Veerdonk, M. Recher, MH. Albert, F. Hauck, S. Seneviratne, J. Pachlopnik Schmid, A. Kolios, G. Unglik, C. Klemann, C. Speckmann, S. Ehl, A. Leichtner, R. Blumberg, A. Franke, S. Snapper, S. Zeissig, C. Cunningham-Rundles, L. Giulino-Roth, O. Elemento, G. Dückers, T. Niehues, E. Fronkova, V. Kanderová, CD. Platt, J. Chou, TA. Chatila, R. Geha, E. McDermott, S. Bunn, M. Kurzai, A. Schulz, L. Alsina, F. Casals, A. Deyà-Martinez, S. Hambleton, H. Kanegane, K. Taskén, O. Neth, B. Grimbacher,
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$a 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 affected mutation 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.
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$a Gabrysch, Annemarie $u Center for Chronic Immunodeficiency (CCI), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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$a Olbrich, Peter $u Sección de Infectología e Inmunopatología, Unidad de Pediatría, Hospital Virgen del Rocío/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain.
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$a Patiño, Virginia $u Immunology Team, American Insurance, Montevideo, Uruguay.
700    1_
$a Warnatz, Klaus $u Center for Chronic Immunodeficiency (CCI), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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$a Wolff, Daniel $u Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany.
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$a Hoshino, Akihiro $u Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
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$a Kobayashi, Masao $u Department of Pediatrics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan.
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$a Imai, Kohsuke $u Department of Community Pediatrics, Perinatal and Maternal Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
700    1_
$a Takagi, Masatoshi $u Department of Community Pediatrics, Perinatal and Maternal Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
700    1_
$a Dybedal, Ingunn $u Department of Hematology, Oslo University Hospital, Oslo, Norway.
700    1_
$a Haddock, Jamanda A $u Department of Radiology, Royal Free Hospital, University College London, London, United Kingdom.
700    1_
$a Sansom, David M $u UCL Institute of Immunity and Transplantation, Royal Free Hospital, London, United Kingdom.
700    1_
$a Lucena, Jose M $u Unidad de Inmunología, Hospital Universitario Virgen del Rocío/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain.
700    1_
$a Seidl, Maximilian $u Center for Chronic Immunodeficiency and Molecular Pathology, Department of Pathology, University Medical Center, University of Freiburg, Freiburg, Germany.
700    1_
$a Schmitt-Graeff, Annette $u Department of Pathology, University Medical Center, University of Freiburg, Freiburg, Germany.
700    1_
$a Reiser, Veronika $u Center for Chronic Immunodeficiency (CCI), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany.
700    1_
$a Emmerich, Florian $u Institute for Transfusion Medicine and Gene Therapy, University Medical Center Freiburg, Freiburg, Germany.
700    1_
$a Frede, Natalie $u Center for Chronic Immunodeficiency (CCI), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
700    1_
$a Bulashevska, Alla $u Center for Chronic Immunodeficiency (CCI), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
700    1_
$a Salzer, Ulrich $u Center for Chronic Immunodeficiency (CCI), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
700    1_
$a Schubert, Desirée $u Center for Chronic Immunodeficiency (CCI), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Spemann Graduate School of Biology and Medicine, Freiburg University, Freiburg, Germany.
700    1_
$a Hayakawa, Seiichi $u Department of Pediatrics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan.
700    1_
$a Okada, Satoshi $u Department of Pediatrics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan.
700    1_
$a Kanariou, Maria $u Department of Immunology and Histocompatibility, Centre for Primary Immunodeficiencies, "Aghia Sophia" Children's Hospital, Athens, Greece.
700    1_
$a Kucuk, Zeynep Yesim $u Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati, Children's Hospital Medical Center, Cincinnati, Ohio.
700    1_
$a Chapdelaine, Hugo $u Department of Medicine, Clinical Immunology and Allergy Division, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada.
700    1_
$a Petruzelkova, Lenka $u Department of Pediatrics, University Hospital Motol and 2nd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
700    1_
$a Sumnik, Zdenek $u Department of Pediatrics, University Hospital Motol and 2nd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
700    1_
$a Sediva, Anna $u Department of Immunology, University Hospital Motol and 2nd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
700    1_
$a Slatter, Mary $u Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Institute of Cellular Medicine, Newcastle University, Newcastle, United Kingdom.
700    1_
$a Arkwright, Peter D $u University of Manchester, Royal Manchester Children's Hospital, Manchester, United Kingdom.
700    1_
$a Cant, Andrew $u Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Institute of Cellular Medicine, Newcastle University, Newcastle, United Kingdom.
700    1_
$a Lorenz, Hanns-Martin $u Division of Rheumatology, Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany.
700    1_
$a Giese, Thomas $u Institute of Immunology, University Hospital Heidelberg, Heidelberg, Germany.
700    1_
$a Lougaris, Vassilios $u Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, Department of Clinical and Experimental Sciences, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy.
700    1_
$a Plebani, Alessandro $u Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, Department of Clinical and Experimental Sciences, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy.
700    1_
$a Price, Christina $u Section of Allergy and Clinical Immunology, Yale University School of Medicine, New Haven, Conn.
700    1_
$a Sullivan, Kathleen E $u Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
700    1_
$a Moutschen, Michel $u Department of Infectious Diseases and General Internal Medicine, University Hospital of Liège, Liege, Belgium.
700    1_
$a Litzman, Jiri $u Department of Clinical Immunology and Allergology, Medical Faculty, Masaryk University, Brno, Czech Republic; Department of Clinical Immunology and Allergology, St Anne's University Hospital, Brno, Czech Republic.
700    1_
$a Freiberger, Tomas $u Molecular Genetics Laboratory, Centre for Cardiovascular Surgery and Transplantation, Brno, Czech Republic; Medical Genomics RG, Central European Institute of Technology, Masaryk University, Brno, Czech Republic.
700    1_
$a van de Veerdonk, Frank L $u Department of Internal Medicine, Radboudumc Center for Infectious Diseases (RCI), Nijmegen, The Netherlands.
700    1_
$a Recher, Mike $u Immunodeficiency Clinic, Medical Outpatient Unit and Immunodeficiency Lab, Department Biomedicine, University Hospital, Basel, Switzerland.
700    1_
$a Albert, Michael H $u Department of Pediatric Immunology and Stem Cell Transplantation, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-Universität, Munich, Germany.
700    1_
$a Hauck, Fabian $u Department of Pediatric Immunology and Stem Cell Transplantation, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-Universität, Munich, Germany.
700    1_
$a Seneviratne, Suranjith $u Institute of Immunology and Transplantation, Royal Free Hospital, University College London, London, United Kingdom.
700    1_
$a Pachlopnik Schmid, Jana $u Division of Immunology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland.
700    1_
$a Kolios, Antonios $u Department of Immunology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
700    1_
$a Unglik, Gary $u Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Melbourne, Australia.
700    1_
$a Klemann, Christian $u Center for Chronic Immunodeficiency (CCI), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Pediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany; Center of Pediatric Surgery, Hannover Medical School, Hannover, Germany.
700    1_
$a Speckmann, Carsten $u Center for Chronic Immunodeficiency (CCI), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for Pediatrics, University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
700    1_
$a Ehl, Stephan $u Center for Chronic Immunodeficiency (CCI), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
700    1_
$a Leichtner, Alan $u Division of Gastroenterology and Department of Pediatrics, Harvard Medical School, Boston, Mass.
700    1_
$a Blumberg, Richard $u Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
700    1_
$a Franke, Andre $u Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany.
700    1_
$a Snapper, Scott $u Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Children's Hospital Boston, Mass.
700    1_
$a Zeissig, Sebastian $u Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Medicine I, University Medical Center Dresden, Technical University Dresden, Dresden, Germany; Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany.
700    1_
$a Cunningham-Rundles, Charlotte $u Mount Sinai Hospital, Mount Sinai St Luke's and Mount Sinai West, Department of Medicine-Allergy & Immunology, New York, NY.
700    1_
$a Giulino-Roth, Lisa $u Department of Pediatrics, Division of Pediatric Hematology/Oncology, Weill Cornell Medicine, New York, NY.
700    1_
$a Elemento, Olivier $u Institute for Computational Biomedicine, Department of Physiology and Biophysics, Weill Cornell Medical College, New York, NY.
700    1_
$a Dückers, Gregor $u HELIOS Children's Hospital, Krefeld, Germany.
700    1_
$a Niehues, Tim $u HELIOS Children's Hospital, Krefeld, Germany.
700    1_
$a Fronkova, Eva $u CLIP, Department of Paediatric Haematology/Oncology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
700    1_
$a Kanderová, Veronika $u CLIP, Department of Paediatric Haematology/Oncology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
700    1_
$a Platt, Craig D $u Division of Immunology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Mass.
700    1_
$a Chou, Janet $u Division of Immunology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Mass.
700    1_
$a Chatila, Talal A $u Division of Immunology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Mass.
700    1_
$a Geha, Raif $u Division of Immunology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Mass.
700    1_
$a McDermott, Elizabeth $u Clinical Immunology and Allergy Unit, Nottingham University Hospitals, Nottingham, United Kingdom.
700    1_
$a Bunn, Su $u Department of Paediatric Gastroenterology, Great North Children's Hospital, Newcastle, United Kingdom.
700    1_
$a Kurzai, Monika $u Department of Pediatrics, University Hospital Jena, Jena, Germany.
700    1_
$a Schulz, Ansgar $u Department of Pediatrics, University Medical Center Ulm, Ulm, Germany.
700    1_
$a Alsina, Laia $u Allergy and Clinical Immunology Department, Functional Unit of Immunology SJD-Clinic, Hospital Sant Joan de Déu, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain.
700    1_
$a Casals, Ferran $u Servei de Genòmica, Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain.
700    1_
$a Deyà-Martinez, Angela $u Allergy and Clinical Immunology Department, Functional Unit of Immunology SJD-Clinic, Hospital Sant Joan de Déu, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain.
700    1_
$a Hambleton, Sophie $u Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Institute of Cellular Medicine, Newcastle University, Newcastle, United Kingdom.
700    1_
$a Kanegane, Hirokazu $u Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
700    1_
$a Taskén, Kjetil $u Centre for Molecular Medicine Norway, Nordic EMBL Partnership, University of Oslo and Institute for Cancer Research, University Hospital Oslo, Oslo, Norway.
700    1_
$a Neth, Olaf $u Sección de Infectología e Inmunopatología, Unidad de Pediatría, Hospital Virgen del Rocío/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain.
700    1_
$a Grimbacher, Bodo $u Center for Chronic Immunodeficiency (CCI), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Institute of Immunology and Transplantation, Royal Free Hospital, University College London, London, United Kingdom. Electronic address: bodo.grimbacher@uniklinik-freiburg.de.
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