Common variable hypogammaglobulinemia, recurrent Pneumocystis carinii pneumonia on intravenous γ-globulin therapy, and natural killer deficiency

Vincent R. Bonagura, Susanna Cunningham-Rundles, Bruce L. Edwards, Norman Todd Ilowite, Josiah F. Wedgwood, David J. Valacer

Research output: Contribution to journalArticle

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Abstract

A toddler with common variable hypoimmunoglobulinemia (CVH), inflammatory bowel disease, and recurrent Pneumocystis carinii pneumonia (PCP) on intravenous gammaglobulin (IVIG) replacement was evaluated for a combined cellular immunodeficiency. He had a normal number of circulating T-cells, natural killer (NK) cells, T-cell subset percentages, and his peripheral blood mononuclear (PBM)-derived B-cell number was low. PBM mitogen blastogenesis and mixed lymphocyte reaction (MLR) were normal. MLR activated T-cells expressed class I and II MHC antigens, interleukin 2 (IL-2), and B-cell growth factor (Il-5)-related receptors. The patient's T-cells induced control B-cell maturation with pokeweed mitogen (PWM-PC), and did not suppress PWM-PC production by allogeneic PBM. Bone marrow (BM) CD19+ B-cell number varied between 10 and 44% of all PBM, and the BM B-cell-enriched fraction failed to differentiate to PWM-PC with autologous or allogeneic T-cell help. The NK activity assayed using K562 target cells was deficient, 9.2 × 7.7% (6.9-9.2%) pt, control 35.9 × 35.8% (16.3-67.2% ± 12.8). In the presence of interferon-α, 800 U/ml, the patient's NK activity increased to 17.2 × 14.9% (12.6-17.2%), control 35.9 × 51.0% (36.5-72.3% ± 12.0). The patient's cell-mediated lympholysis of HLA nonidentical, allogeneic stimulators was normal. Maintaining trough serum IgG levels above 500 mg/dl was required to suppress recurrent PCP. This functional NK deficiency may be relevant to the development of recurrent PCP in IVIG-treated CVH patients.

Original languageEnglish (US)
Pages (from-to)216-231
Number of pages16
JournalClinical Immunology and Immunopathology
Volume51
Issue number2
DOIs
StatePublished - 1989
Externally publishedYes

Fingerprint

Common Variable Immunodeficiency
Pneumocystis Pneumonia
Globulins
B-Lymphocytes
T-Lymphocytes
Mixed Lymphocyte Culture Test
Intravenous Immunoglobulins
Cell Count
Therapeutics
Pokeweed Mitogens
K562 Cells
T-Lymphocyte Subsets
Lymphocyte Activation
Mitogens
Inflammatory Bowel Diseases
Natural Killer Cells
Bone Marrow Cells
Interferons
Interleukin-2
Intercellular Signaling Peptides and Proteins

ASJC Scopus subject areas

  • Immunology
  • Immunology and Allergy
  • Pathology and Forensic Medicine

Cite this

Common variable hypogammaglobulinemia, recurrent Pneumocystis carinii pneumonia on intravenous γ-globulin therapy, and natural killer deficiency. / Bonagura, Vincent R.; Cunningham-Rundles, Susanna; Edwards, Bruce L.; Ilowite, Norman Todd; Wedgwood, Josiah F.; Valacer, David J.

In: Clinical Immunology and Immunopathology, Vol. 51, No. 2, 1989, p. 216-231.

Research output: Contribution to journalArticle

Bonagura, Vincent R. ; Cunningham-Rundles, Susanna ; Edwards, Bruce L. ; Ilowite, Norman Todd ; Wedgwood, Josiah F. ; Valacer, David J. / Common variable hypogammaglobulinemia, recurrent Pneumocystis carinii pneumonia on intravenous γ-globulin therapy, and natural killer deficiency. In: Clinical Immunology and Immunopathology. 1989 ; Vol. 51, No. 2. pp. 216-231.
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abstract = "A toddler with common variable hypoimmunoglobulinemia (CVH), inflammatory bowel disease, and recurrent Pneumocystis carinii pneumonia (PCP) on intravenous gammaglobulin (IVIG) replacement was evaluated for a combined cellular immunodeficiency. He had a normal number of circulating T-cells, natural killer (NK) cells, T-cell subset percentages, and his peripheral blood mononuclear (PBM)-derived B-cell number was low. PBM mitogen blastogenesis and mixed lymphocyte reaction (MLR) were normal. MLR activated T-cells expressed class I and II MHC antigens, interleukin 2 (IL-2), and B-cell growth factor (Il-5)-related receptors. The patient's T-cells induced control B-cell maturation with pokeweed mitogen (PWM-PC), and did not suppress PWM-PC production by allogeneic PBM. Bone marrow (BM) CD19+ B-cell number varied between 10 and 44{\%} of all PBM, and the BM B-cell-enriched fraction failed to differentiate to PWM-PC with autologous or allogeneic T-cell help. The NK activity assayed using K562 target cells was deficient, 9.2 × 7.7{\%} (6.9-9.2{\%}) pt, control 35.9 × 35.8{\%} (16.3-67.2{\%} ± 12.8). In the presence of interferon-α, 800 U/ml, the patient's NK activity increased to 17.2 × 14.9{\%} (12.6-17.2{\%}), control 35.9 × 51.0{\%} (36.5-72.3{\%} ± 12.0). The patient's cell-mediated lympholysis of HLA nonidentical, allogeneic stimulators was normal. Maintaining trough serum IgG levels above 500 mg/dl was required to suppress recurrent PCP. This functional NK deficiency may be relevant to the development of recurrent PCP in IVIG-treated CVH patients.",
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