Bare lymphocyte syndrome type II

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Bare lymphocyte syndrome type II
Other namesHLA class 2-negative severe combined immunodeficiency, HLA Class 2-Negative
Autosomal recessive - en.svg
Bare lymphocyte syndrome 2 is autosomal recessive in inheritance
Specialty Immunology, pediatrics, endocrinology   OOjs UI icon edit-ltr-progressive.svg
Symptoms Neutropenia [1]
CausesAbsence of human leukocyte antigen class II expression [1]
Diagnostic method Genetic test [1]
Medication Bone marrow transplant [2]

Bare lymphocyte syndrome type II (BLS II) is a rare recessive genetic condition in which a group of genes called major histocompatibility complex class II (MHC class II) are not expressed. [3] [4] The result is that the immune system is severely compromised and cannot effectively fight infection.[ medical citation needed ]

Contents

Symptoms and signs

Among the signs and symptoms that Bare lymphocyte syndrome type II exhibits are the following: [1] [5]

Cause

The genetic cause of Bare lymphocyte syndrome type II is due to mutations in any of the following genes: [5]

Mechanism

MHC Class 2 MHC Class 2.svg
MHC Class 2

Major histocompatibility complex class II proteins are important because under normal function they have important responsibility in the human body's immune system response. MHC II proteins present exogenous antigens that activate CD4+ T-lymphocytes, immune cells that are responsible for activating other immune cells like CD8+ T-lymphocytes and macrophages. [10] MHC II proteins are also important for positive and negative selection in the thymus because they present antigens to immature T-cells, allowing the T cells to differentiate into proper functioning CD4+ T-lymphocytes. This may explain why patients with BLS II display decreased levels of CD4+ T-lymphocytes in their blood. [11]

The basis for BLSII is not due to defects in the MHC II genes themselves, it is the result of mutations in genes that code for proteins, transcription factors that normally regulate the expression of the MHC II genes. One of the several proteins that are required to switch on MHC II genes in various cells types is absent. [5]

Diagnosis

The diagnosis for Bare lymphocyte syndrome type II can be done via genetic testing [12] A blood test could indicate decreased CD4+ T-cells(T-helper lymphocyte), as well as serum immunoglobulin [2]

Management

Bone marrow KM Transplantat.JPEG
Bone marrow

In terms of treatment for major histocompatibility complex class II deficiency(Bare lymphocyte syndrome type II), one finds that according to Matheux, et al. a possible treatment for this condition might be found in cellular and gene therapy [13] The prognosis is poor (without treatment) in early childhood for this condition; [14] [2] additional treatment options include anti-microbial prophylaxis prior to bone marrow transplant [2] [15]

See also

Related Research Articles

Histocompatibility, or tissue compatibility, is the property of having the same, or sufficiently similar, alleles of a set of genes called human leukocyte antigens (HLA), or major histocompatibility complex (MHC). Each individual expresses many unique HLA proteins on the surface of their cells, which signal to the immune system whether a cell is part of the self or an invading organism. T cells recognize foreign HLA molecules and trigger an immune response to destroy the foreign cells. Histocompatibility testing is most relevant for topics related to whole organ, tissue, or stem cell transplants, where the similarity or difference between the donor's HLA alleles and the recipient's triggers the immune system to reject the transplant. The wide variety of potential HLA alleles lead to unique combinations in individuals and make matching difficult.

<span class="mw-page-title-main">Major histocompatibility complex</span> Cell surface proteins, part of the acquired immune system

The major histocompatibility complex (MHC) is a large locus on vertebrate DNA containing a set of closely linked polymorphic genes that code for cell surface proteins essential for the adaptive immune system. These cell surface proteins are called MHC molecules.

<span class="mw-page-title-main">Human leukocyte antigen</span> Genes on human chromosome 6

The human leukocyte antigen (HLA) system or complex is a complex of genes on chromosome 6 in humans which encode cell-surface proteins responsible for regulation of the immune system. The HLA system is also known as the human version of the major histocompatibility complex (MHC) found in many animals.

A class II gene is a type of gene that codes for a protein. Class II genes are transcribed by RNAP II.

Antigen processing, or the cytosolic pathway, is an immunological process that prepares antigens for presentation to special cells of the immune system called T lymphocytes. It is considered to be a stage of antigen presentation pathways. This process involves two distinct pathways for processing of antigens from an organism's own (self) proteins or intracellular pathogens, or from phagocytosed pathogens ; subsequent presentation of these antigens on class I or class II major histocompatibility complex (MHC) molecules is dependent on which pathway is used. Both MHC class I and II are required to bind antigen before they are stably expressed on a cell surface. MHC I antigen presentation typically involves the endogenous pathway of antigen processing, and MHC II antigen presentation involves the exogenous pathway of antigen processing. Cross-presentation involves parts of the exogenous and the endogenous pathways but ultimately involves the latter portion of the endogenous pathway.

<span class="mw-page-title-main">Chromosome 6</span> Human chromosome

Chromosome 6 is one of the 23 pairs of chromosomes in humans. People normally have two copies of this chromosome. Chromosome 6 spans more than 172 million base pairs and represents between 5.5 and 6% of the total DNA in cells. It contains the major histocompatibility complex, which contains over 100 genes related to the immune response, and plays a vital role in organ transplantation.

<span class="mw-page-title-main">Jan Klein</span> Czech immunologist

Jan Klein is a Czech-American immunologist, best known for his work on the major histocompatibility complex (MHC). He was born in 1936 in Stemplovec, Opava, Czech Republic. He graduated from the Charles University at Prague, in 1955, and received his M.S. in botany from the same school in 1958. He was a teacher at the Neruda High School in Prague from 1958 to 1961. He received his Ph.D. in genetics from the Czechoslovak Academy of Sciences in 1965, and moved to Stanford University as a postdoctoral fellow the same year. He became assistant professor in 1969, and associate professor in 1973 at the University of Michigan. He assumed the position of professor at the University of Texas Southwestern Medical School in 1975. From 1977 to his retirement in 2004, he was the director of the Max-Planck-Institut für Biologie at Tübingen, Germany. He is currently a Frances R. and Helen M. Pentz Visiting Professor of Science and adjunct professor of biology at the Pennsylvania State University.

<span class="mw-page-title-main">HLA-DRA</span> Protein-coding gene in the species Homo sapiens

HLA class II histocompatibility antigen, DR alpha chain is a protein that in humans is encoded by the HLA-DRA gene. HLA-DRA encodes the alpha subunit of HLA-DR. Unlike the alpha chains of other Human MHC class II molecules, the alpha subunit is practically invariable. However it can pair with, in any individual, the beta chain from 3 different DR beta loci, DRB1, and two of any DRB3, DRB4, or DRB5 alleles. Thus there is the potential that any given individual can form 4 different HLA-DR isoforms.

Bare lymphocyte syndrome is a condition caused by mutations in certain genes of the major histocompatibility complex or involved with the processing and presentation of MHC molecules. It is a form of severe combined immunodeficiency.

<span class="mw-page-title-main">Antigen presentation</span> Vital immune process that is essential for T cell immune response triggering

Antigen presentation is a vital immune process that is essential for T cell immune response triggering. Because T cells recognize only fragmented antigens displayed on cell surfaces, antigen processing must occur before the antigen fragment, now bound to the major histocompatibility complex (MHC), is transported to the surface of the cell, a process known as presentation, where it can be recognized by a T-cell receptor. If there has been an infection with viruses or bacteria, the cell will present an endogenous or exogenous peptide fragment derived from the antigen by MHC molecules. There are two types of MHC molecules which differ in the behaviour of the antigens: MHC class I molecules (MHC-I) bind peptides from the cell cytosol, while peptides generated in the endocytic vesicles after internalisation are bound to MHC class II (MHC-II). Cellular membranes separate these two cellular environments - intracellular and extracellular. Each T cell can only recognize tens to hundreds of copies of a unique sequence of a single peptide among thousands of other peptides presented on the same cell, because an MHC molecule in one cell can bind to quite a large range of peptides. Predicting which antigens will be presented to the immune system by a certain MHC/HLA type is difficult, but the technology involved is improving.

<span class="mw-page-title-main">MHC class II</span> Protein of the immune system

MHC Class II molecules are a class of major histocompatibility complex (MHC) molecules normally found only on professional antigen-presenting cells such as dendritic cells, mononuclear phagocytes, some endothelial cells, thymic epithelial cells, and B cells. These cells are important in initiating immune responses.

<span class="mw-page-title-main">Minor histocompatibility antigen</span>

Minor histocompatibility antigen are peptides presented on the cellular surface of donated organs that are known to give an immunological response in some organ transplants. They cause problems of rejection less frequently than those of the major histocompatibility complex (MHC). Minor histocompatibility antigens (MiHAs) are diverse, short segments of proteins and are referred to as peptides. These peptides are normally around 9-12 amino acids in length and are bound to both the major histocompatibility complex (MHC) class I and class II proteins. Peptide sequences can differ among individuals and these differences arise from SNPs in the coding region of genes, gene deletions, frameshift mutations, or insertions. About a third of the characterized MiHAs come from the Y chromosome. Prior to becoming a short peptide sequence, the proteins expressed by these polymorphic or diverse genes need to be digested in the proteasome into shorter peptides. These endogenous or self peptides are then transported into the endoplasmic reticulum with a peptide transporter pump called TAP where they encounter and bind to the MHC class I molecule. This contrasts with MHC class II molecules's antigens which are peptides derived from phagocytosis/endocytosis and molecular degradation of non-self entities' proteins, usually by antigen-presenting cells. MiHA antigens are either ubiquitously expressed in most tissue like skin and intestines or restrictively expressed in the immune cells.

<span class="mw-page-title-main">CIITA</span> Protein-coding gene in the species Homo sapiens

CIITA is a human gene which encodes a protein called the class II, major histocompatibility complex, transactivator. Mutations in this gene are responsible for the bare lymphocyte syndrome in which the immune system is severely compromised and cannot effectively fight infection. Chromosomal rearrangement of CIITA is involved in the pathogenesis of Hodgkin lymphoma and primary mediastinal B cell lymphoma.

<span class="mw-page-title-main">HLA-DQB1</span> Protein-coding gene in the species Homo sapiens

Major histocompatibility complex, class II, DQ beta 1, also known as HLA-DQB1, is a human gene and also denotes the genetic locus that contains this gene. The protein encoded by this gene is one of two proteins that are required to form the DQ heterodimer, a cell surface receptor essential to the function of the immune system.

<span class="mw-page-title-main">Major histocompatibility complex, class II, DQ alpha 1</span> Protein-coding gene in the species Homo sapiens

Major histocompatibility complex, class II, DQ alpha 1, also known as HLA-DQA1, is a human gene present on short arm of chromosome 6 (6p21.3) and also denotes the genetic locus which contains this gene. The protein encoded by this gene is one of two proteins that are required to form the DQ heterodimer, a cell surface receptor essential to the function of the immune system.

<span class="mw-page-title-main">HLA-DMB</span> Protein-coding gene in the species Homo sapiens

HLA class II histocompatibility antigen, DM beta chain is a protein that in humans is encoded by the HLA-DMB gene.

<span class="mw-page-title-main">RFX5</span> Protein-coding gene in the species Homo sapiens

DNA-binding protein RFX5 is a protein that in humans is encoded by the RFX5 gene.

<span class="mw-page-title-main">RFXANK</span> Protein-coding gene in the species Homo sapiens

DNA-binding protein RFXANK is a protein that in humans is encoded by the RFXANK gene.

<span class="mw-page-title-main">RFXAP</span> Protein-coding gene in the species Homo sapiens

Regulatory factor X-associated protein is a protein that in humans is encoded by the RFXAP gene.

<span class="mw-page-title-main">HLA-DQB2</span> Protein-coding gene in the species Homo sapiens

HLA class II histocompatibility antigen, DX beta chain is a protein that in humans is encoded by the HLA-DQB2 gene.

References

  1. 1 2 3 4 "Bare lymphocyte syndrome 2 | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program". rarediseases.info.nih.gov. Retrieved 2017-07-28.
  2. 1 2 3 4 al.], Stephan Strobel ... [et; Smith, Peter K. (2006). Paediatrics and Child Health the Great Ormond Street Handbook. London: Manson Pub. p. 465. ISBN   9781840765625 . Retrieved 28 July 2017.
  3. "OMIM Entry - # 209920 - BARE LYMPHOCYTE SYNDROME, TYPE II". omim.org. Retrieved 2017-07-13.
  4. Reference, Genetics Home. "bare lymphocyte syndrome type II". Genetics Home Reference. Retrieved 2017-07-13.
  5. 1 2 3 "SCID due to absent class II HLA antigens (Concept Id: C0242583) - MedGen - NCBI". www.ncbi.nlm.nih.gov. Retrieved 2017-07-28.
  6. Reference, Genetics Home. "CIITA gene". Genetics Home Reference. Retrieved 2017-07-28.
  7. Reference, Genetics Home. "RFX5 gene". Genetics Home Reference. Retrieved 2017-07-28.
  8. Reference, Genetics Home. "RFXANK gene". Genetics Home Reference. Retrieved 2017-07-28.
  9. Reference, Genetics Home. "RFXAP gene". Genetics Home Reference. Retrieved 2017-07-28.
  10. Reith, Walter; Picard, Capucine (2016). "Major Histocompatibility Complex Class II Deficiency". Academic Press. 5: 378–390. Retrieved 4 December 2020.
  11. DeSandro, Angela; Nagarajan, Uma; Boss, Jeremy (September 2017). "Associations and Interactions between Bare Lymphocyte Syndrome Factors". Molecular and Cellular Biology. 20 (17): 6587–6599. doi: 10.1128/mcb.20.17.6587-6599.2000 . PMC   86141 . PMID   10938133.
  12. "Bare lymphocyte syndrome type 2, complementation group A - Conditions - GTR - NCBI". www.ncbi.nlm.nih.gov. Retrieved 2017-07-28.
  13. Matheux, Franck; Villard, Jean (June 2004). "Cellular and gene therapy for major histocompatibility complex class II deficiency". News in Physiological Sciences. 19 (3): 154–158. doi:10.1152/nips.01462.2003. ISSN   0886-1714. PMID   15143213.
  14. RESERVED, INSERM US14 -- ALL RIGHTS. "Orphanet: Immunodeficiency by defective expression of HLA class 2". www.orpha.net. Retrieved 2017-07-28.
  15. Bratzler, Dale W.; Dellinger, E. Patchen; Olsen, Keith M.; Perl, Trish M.; Auwaerter, Paul G.; Bolon, Maureen K.; Fish, Douglas N.; Napolitano, Lena M.; Sawyer, Robert G. (February 2013). "Clinical practice guidelines for antimicrobial prophylaxis in surgery" (PDF). Surgical Infections. 14 (1): 73–156. doi:10.1089/sur.2013.9999. hdl: 2027.42/140217 . ISSN   1557-8674. PMID   23461695.subscription needed

Further reading