TY - JOUR
T1 - Common variable hypogammaglobulinemia, recurrent Pneumocystis carinii pneumonia on intravenous γ-globulin therapy, and natural killer deficiency
AU - Bonagura, Vincent R.
AU - Cunningham-Rundles, Susanna
AU - Edwards, Bruce L.
AU - Ilowite, Norman T.
AU - Wedgwood, Josiah F.
AU - Valacer, David J.
PY - 1989/5
Y1 - 1989/5
N2 - 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.
AB - 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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U2 - 10.1016/0090-1229(89)90021-4
DO - 10.1016/0090-1229(89)90021-4
M3 - Article
C2 - 2784754
AN - SCOPUS:0024498863
SN - 0090-1229
VL - 51
SP - 216
EP - 231
JO - Clinical Immunology and Immunopathology
JF - Clinical Immunology and Immunopathology
IS - 2
ER -