Spectrum of clinical presentations in familial hemophagocytic lymphohistiocytosis type 5 patients with mutations in STXBP2.

Abstract:

:Hemophagocytic lymphohistiocytosis (HLH) is an often-fatal hyperinflammatory syndrome characterized by fever, hepatosplenomegaly, cytopenia, and in some cases hemophagocytosis. Here, we describe the mutation analysis, clinical presentation, and functional analysis of natural killer (NK) cells in patients with mutations in STXBP2 encoding Munc18-2, recently associated with familial HLH type 5. The disease severity among 11 persons studied here was highly variable and, accordingly, age at diagnosis ranged from 2 months to 17 years. Remarkably, in addition to typical manifestations of familial HLH (FHL), the clinical findings included colitis, bleeding disorders, and hypogammaglobulinemia in approximately one-third of the patients. Laboratory analysis revealed impairment of NK-cell degranulation and cytotoxic capacity. Interleukin-2 stimulation of lymphocytes in vitro rescued the NK cell-associated functional defects. In conclusion, familial HLH type 5 is associated with a spectrum of clinical symptoms, which may be a reflection of impaired expression and function of Munc18-2 also in cells other than cytotoxic lymphocytes. Mutations in STXBP2 should thus also be considered in patients with clinical manifestations other than those typically associated with HLH.

journal_name

Blood

journal_title

Blood

authors

Meeths M,Entesarian M,Al-Herz W,Chiang SC,Wood SM,Al-Ateeqi W,Almazan F,Boelens JJ,Hasle H,Ifversen M,Lund B,van den Berg JM,Gustafsson B,Hjelmqvist H,Nordenskjöld M,Bryceson YT,Henter JI

doi

10.1182/blood-2010-05-282541

subject

Has Abstract

pub_date

2010-10-14 00:00:00

pages

2635-43

issue

15

eissn

0006-4971

issn

1528-0020

pii

blood-2010-05-282541

journal_volume

116

pub_type

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