Angela Deyà-Martínez1,2, Ana Esteve-Solé1,2, Natalia Vélez-Tirado3, Veronica Celis4, Jordi Costa5, Maria Cols5, Cristina Jou6, Alexandru Vlagea2,7, Ana María Plaza-Martin1,2, Manel Juan2,7, Laia Alsina1,2. 1. Allergy and Clinical Immunology Department, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain. 2. Functional Unit of Clinical Immunology, Hospital Sant Joan de Déu-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain. 3. Universidad Militar Nueva Granada, Bogotá, Colombia. 4. Department of Pediatric oncology, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain. 5. Department of Pediatric Pneumology, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain. 6. Department of Pathology, Hospital Sant Joan de Déu, Barcelona, Spain. 7. Immunology Department, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
Abstract
BACKGROUND: One of the most frequent non-infectious complications of humoral immunodeficiencies with a CVID-like pattern is a particular form of inflammatory lung disease which is called granulomatous-lymphocytic interstitial lung disease (GLILD). Its development worsens patient prognosis, with a significant decrease in survival. Currently, there are no unified guidelines regarding its management, and different combinations of immunosuppressants have been used with variable success. METHODS: Clinical and radiological data were collected from patient's medical charts. Flow cytometry was performed to characterize the immunological features with special focus in regulatory T cells (Tregs). RESULTS: A 16-year-old girl with Kabuki syndrome and a 12-year-old boy, both with a CVID-like humoral immunodeficiency on immunoglobulin replacement treatment, developed during follow-up an inflammatory complication radiologically, clinically, and histologically compatible with GLILD. They required treatment, and sirolimus was started, with very good response and no serious side effects. CONCLUSIONS: These 2 cases provide insight into the underlying local and systemic immune anomalies involved in the development of GLILD, including the possible role of Tregs. Combined chemotherapy is commonly used as treatment for GLILD when steroids fail, but there have been some reports of successful monotherapy. As far as we know, these are the first 2 GLILD patients treated successfully with sirolimus, suggesting the advisability of further study of mTOR inhibitors as a more targeted treatment for GLILD, if impairment in Tregs is demonstrated.
BACKGROUND: One of the most frequent non-infectious complications of humoral immunodeficiencies with a CVID-like pattern is a particular form of inflammatory lung disease which is called granulomatous-lymphocytic interstitial lung disease (GLILD). Its development worsens patient prognosis, with a significant decrease in survival. Currently, there are no unified guidelines regarding its management, and different combinations of immunosuppressants have been used with variable success. METHODS: Clinical and radiological data were collected from patient's medical charts. Flow cytometry was performed to characterize the immunological features with special focus in regulatory T cells (Tregs). RESULTS: A 16-year-old girl with Kabuki syndrome and a 12-year-old boy, both with a CVID-like humoral immunodeficiency on immunoglobulin replacement treatment, developed during follow-up an inflammatory complication radiologically, clinically, and histologically compatible with GLILD. They required treatment, and sirolimus was started, with very good response and no serious side effects. CONCLUSIONS: These 2 cases provide insight into the underlying local and systemic immune anomalies involved in the development of GLILD, including the possible role of Tregs. Combined chemotherapy is commonly used as treatment for GLILD when steroids fail, but there have been some reports of successful monotherapy. As far as we know, these are the first 2 GLILDpatients treated successfully with sirolimus, suggesting the advisability of further study of mTOR inhibitors as a more targeted treatment for GLILD, if impairment in Tregs is demonstrated.
Authors: Olivia A C Lamers; Bas M Smits; Helen Louisa Leavis; Godelieve J de Bree; Charlotte Cunningham-Rundles; Virgil A S H Dalm; Hsi-En Ho; John R Hurst; Hanna IJspeert; Sabine M P J Prevaes; Alex Robinson; Astrid C van Stigt; Suzanne Terheggen-Lagro; Annick A J M van de Ven; Klaus Warnatz; Janneke H H M van de Wijgert; Joris van Montfrans Journal: Front Immunol Date: 2021-04-15 Impact factor: 7.561