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Published in: Indian Journal of Pediatrics 8/2016

01-08-2016 | Original Article

Leukocyte Adhesion Deficiency-I: Clinical and Molecular Characterization in an Indian Population

Authors: Prashant Deshpande, Kotteeswari Kathirvel, Ansu Abu Alex, Anu Korula, Biju George, RV Shaji, Vikram Mathews

Published in: Indian Journal of Pediatrics | Issue 8/2016

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Abstract

Objective

To describe clinical and flow cytometric immunophenotyping details of 26 patients of Leukocyte adhesion deficiency-I (LAD-I) along with molecular characterization of 7 patients.

Methods

Diagnosis of LAD-I was suspected on the basis of clinical features, white blood cell count and absolute neutrophil counts and flow cytometric assessment of expression of CD18 and CD11(a, b, c) on leukocytes. Mutation analysis was performed using DNA PCR and conformation sensitive gel electrophoresis (CSGE) technique followed by sequencing.

Results

All the patients were symptomatic by the age of 6 mo, with history of recurrent bacterial infections involving skin, mucosa or umbilical cord (omphalitis) being the most frequent presenting symptoms. White blood cells (WBC) and absolute neutrophil counts (ANC) were markedly elevated, without any specific morphological findings. On flow cytometry, CD11a and CD11c showed moderate correlation with CD18 expression. Mutation analysis was performed in 7 patients and six different mutations (4 missense, 2 nonsense and 1 splice site) were identified, all of which were homozygous in nature.

Conclusions

A presentation of repeated bacterial infections during infancy, especially omphalitis, with markedly elevated absolute neutrophil counts should trigger investigations for LAD-I including flow cytometric analysis of CD11/CD18 expression.
Literature
1.
go back to reference Harris ES, McIntyre TM, Prescott SM, Zimmerman GA. The leukocyte integrins. J Biol Chem. 2000;275:23409–12.CrossRefPubMed Harris ES, McIntyre TM, Prescott SM, Zimmerman GA. The leukocyte integrins. J Biol Chem. 2000;275:23409–12.CrossRefPubMed
2.
go back to reference Schymeinsky J, Mócsai A, Walzog B. Neutrophil activation via beta2 integrins (CD11/CD18): molecular mechanisms and clinical implications. Thromb Haemost. 2007;98:262–73.PubMed Schymeinsky J, Mócsai A, Walzog B. Neutrophil activation via beta2 integrins (CD11/CD18): molecular mechanisms and clinical implications. Thromb Haemost. 2007;98:262–73.PubMed
3.
go back to reference Mazzone A, Ricevuti G. Leukocyte CD11/CD18 integrins: biological and clinical relevance. Haematologica. 1995;80:161–75.PubMed Mazzone A, Ricevuti G. Leukocyte CD11/CD18 integrins: biological and clinical relevance. Haematologica. 1995;80:161–75.PubMed
4.
go back to reference Pavalko FM, LaRoche SM. Activation of human neutrophils induces an interaction between the integrin beta 2-subunit (CD18) and the actin binding protein alpha-actinin. J Immunol. 1993;151:3795–807.PubMed Pavalko FM, LaRoche SM. Activation of human neutrophils induces an interaction between the integrin beta 2-subunit (CD18) and the actin binding protein alpha-actinin. J Immunol. 1993;151:3795–807.PubMed
5.
go back to reference Walzog B, Weinmann P, Jeblonski F, Scharffetter-Kochanek K, Bommert K, Gaehtgens P. A role for β2 integrins (CD11/CD18) in the regulation of cytokine gene expression of polymorphonuclear neutrophils during the inflammatory response. FASEB J. 1999;13:1855–65.PubMed Walzog B, Weinmann P, Jeblonski F, Scharffetter-Kochanek K, Bommert K, Gaehtgens P. A role for β2 integrins (CD11/CD18) in the regulation of cytokine gene expression of polymorphonuclear neutrophils during the inflammatory response. FASEB J. 1999;13:1855–65.PubMed
6.
go back to reference Etzioni A. Leukocyte adhesion deficiencies: molecular basis, clinical findings, and therapeutic options. Adv Exp Med Biol. 2007;601:51–60.CrossRefPubMed Etzioni A. Leukocyte adhesion deficiencies: molecular basis, clinical findings, and therapeutic options. Adv Exp Med Biol. 2007;601:51–60.CrossRefPubMed
7.
go back to reference Boxer LA, Newburger PE. Disorders of phagocyte function. In: Kliegman R, Nelson WE, editors. Nelson textbook of pediatrics. 19th ed. Philadelphia: Elsevier; 2011. p. 741.CrossRef Boxer LA, Newburger PE. Disorders of phagocyte function. In: Kliegman R, Nelson WE, editors. Nelson textbook of pediatrics. 19th ed. Philadelphia: Elsevier; 2011. p. 741.CrossRef
8.
go back to reference van de Vijver E, van den Berg TK, Kuijpers TW. Leukocyte adhesion deficiencies. Hematol Oncol Clin North Am. 2013;27:101–16. viii.CrossRefPubMed van de Vijver E, van den Berg TK, Kuijpers TW. Leukocyte adhesion deficiencies. Hematol Oncol Clin North Am. 2013;27:101–16. viii.CrossRefPubMed
9.
go back to reference Madkaikar M, Italia K, Gupta M, et al. Molecular characterization of leukocyte adhesion deficiency-I in Indian patients: identification of 9 novel mutations. Blood Cells Mol Dis. 2015;54:217–23.CrossRefPubMed Madkaikar M, Italia K, Gupta M, et al. Molecular characterization of leukocyte adhesion deficiency-I in Indian patients: identification of 9 novel mutations. Blood Cells Mol Dis. 2015;54:217–23.CrossRefPubMed
10.
go back to reference van de Vijver E, Maddalena A, Sanal Ö, et al. Hematologically important mutations: leukocyte adhesion deficiency (first update). Blood Cells Mol Dis. 2012;48:53–61.CrossRefPubMed van de Vijver E, Maddalena A, Sanal Ö, et al. Hematologically important mutations: leukocyte adhesion deficiency (first update). Blood Cells Mol Dis. 2012;48:53–61.CrossRefPubMed
11.
12.
go back to reference Mathew EC, Shaw JM, Bonilla FA, Law SK, Wright DA. A novel point mutation in CD18 causing the expression of dysfunctional CD11/CD18 leucocyte integrins in a patient with leucocyte adhesion deficiency (LAD). Clin Exp Immunol. 2000;121:133–8.CrossRefPubMedPubMedCentral Mathew EC, Shaw JM, Bonilla FA, Law SK, Wright DA. A novel point mutation in CD18 causing the expression of dysfunctional CD11/CD18 leucocyte integrins in a patient with leucocyte adhesion deficiency (LAD). Clin Exp Immunol. 2000;121:133–8.CrossRefPubMedPubMedCentral
13.
go back to reference Patkar N, Alex AA, B B, et al. Standardizing minimal residual disease by flow cytometry for precursor B lineage acute lymphoblastic leukemia in a developing country. Cytometry B Clin Cytom. 2012;82:252–8.CrossRefPubMed Patkar N, Alex AA, B B, et al. Standardizing minimal residual disease by flow cytometry for precursor B lineage acute lymphoblastic leukemia in a developing country. Cytometry B Clin Cytom. 2012;82:252–8.CrossRefPubMed
14.
go back to reference Kumar P, Henikoff S, Ng PC. Predicting the effects of coding non-synonymous variants on protein function using the SIFT algorithm. Nat Protoc. 2009;4:1073–81.CrossRefPubMed Kumar P, Henikoff S, Ng PC. Predicting the effects of coding non-synonymous variants on protein function using the SIFT algorithm. Nat Protoc. 2009;4:1073–81.CrossRefPubMed
15.
go back to reference Schwarz JM, Cooper DN, Schuelke M, Seelow D. MutationTaster2: mutation prediction for the deep-sequencing age. Nat Methods. 2014;11:361–2.CrossRefPubMed Schwarz JM, Cooper DN, Schuelke M, Seelow D. MutationTaster2: mutation prediction for the deep-sequencing age. Nat Methods. 2014;11:361–2.CrossRefPubMed
16.
go back to reference Ohashi Y, Yambe T, Tsuchiya S, Kikuchi H, Konno T. Familial genetic defect in a case of leukocyte adhesion deficiency. Hum Mutat. 1993;2:458–67.CrossRefPubMed Ohashi Y, Yambe T, Tsuchiya S, Kikuchi H, Konno T. Familial genetic defect in a case of leukocyte adhesion deficiency. Hum Mutat. 1993;2:458–67.CrossRefPubMed
17.
go back to reference Matsuura S, Kishi F, Tsukahara M, et al. Leukocyte adhesion deficiency: identification of novel mutations in two Japanese patients with a severe form. Biochem Biophys Res Commun. 1992;184:1460–7.CrossRefPubMed Matsuura S, Kishi F, Tsukahara M, et al. Leukocyte adhesion deficiency: identification of novel mutations in two Japanese patients with a severe form. Biochem Biophys Res Commun. 1992;184:1460–7.CrossRefPubMed
18.
go back to reference Lorusso F, Kong D, Jalil AKA, Sylvestre C, Tan SL, Ao A. Preimplantation genetic diagnosis of leukocyte adhesion deficiency type I. Fertil Steril. 2006;85:494.e15–8.CrossRef Lorusso F, Kong D, Jalil AKA, Sylvestre C, Tan SL, Ao A. Preimplantation genetic diagnosis of leukocyte adhesion deficiency type I. Fertil Steril. 2006;85:494.e15–8.CrossRef
19.
go back to reference Shigeoka AO. Delayed umbilical cord separation is NOT commonly associated with leukocyte adhesion deficiency. Pediatr Res. 1999;45:12A.CrossRef Shigeoka AO. Delayed umbilical cord separation is NOT commonly associated with leukocyte adhesion deficiency. Pediatr Res. 1999;45:12A.CrossRef
20.
go back to reference Razvi S, Murphy R, Shlasko E, Cunningham-Rundles C. Delayed separation of the umbilical cord attributable to urachal anomalies. Pediatrics. 2001;108:493–4.CrossRefPubMed Razvi S, Murphy R, Shlasko E, Cunningham-Rundles C. Delayed separation of the umbilical cord attributable to urachal anomalies. Pediatrics. 2001;108:493–4.CrossRefPubMed
21.
go back to reference Movahedi M, Entezari N, Pourpak Z, et al. Clinical and laboratory findings in Iranian patients with leukocyte adhesion deficiency (study of 15 cases). J Clin Immunol. 2007;27:302–7.CrossRefPubMed Movahedi M, Entezari N, Pourpak Z, et al. Clinical and laboratory findings in Iranian patients with leukocyte adhesion deficiency (study of 15 cases). J Clin Immunol. 2007;27:302–7.CrossRefPubMed
22.
go back to reference Majorana A, Notarangelo LD, Savoldi E, Gastaldi G, Lozada-Nur F. Leukocyte adhesion deficiency in a child with severe oral involvement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;87:691–4.CrossRefPubMed Majorana A, Notarangelo LD, Savoldi E, Gastaldi G, Lozada-Nur F. Leukocyte adhesion deficiency in a child with severe oral involvement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;87:691–4.CrossRefPubMed
23.
go back to reference Cox DP, Weathers DR. Leukocyte adhesion deficiency type 1: an important consideration in the clinical differential diagnosis of prepubertal periodontitis. A case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105:86–90.CrossRefPubMed Cox DP, Weathers DR. Leukocyte adhesion deficiency type 1: an important consideration in the clinical differential diagnosis of prepubertal periodontitis. A case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105:86–90.CrossRefPubMed
24.
go back to reference Madkaikar MR, Gupta M, Rao M, Ghosh K. Prenatal diagnosis of LAD-I on cord blood by flowcytometry. Indian J Pediatr. 2012;79:1605–9.CrossRefPubMed Madkaikar MR, Gupta M, Rao M, Ghosh K. Prenatal diagnosis of LAD-I on cord blood by flowcytometry. Indian J Pediatr. 2012;79:1605–9.CrossRefPubMed
25.
go back to reference Mishra A, Gupta M, Dalvi A, Ghosh K, Madkaikar M. Rapid flow cytometric prenatal diagnosis of primary immunodeficiency (PID) disorders. J Clin Immunol. 2014;34:316–22.CrossRefPubMed Mishra A, Gupta M, Dalvi A, Ghosh K, Madkaikar M. Rapid flow cytometric prenatal diagnosis of primary immunodeficiency (PID) disorders. J Clin Immunol. 2014;34:316–22.CrossRefPubMed
26.
go back to reference Sligh JE, Hurwitz MY, Zhu CM, Anderson DC, Beaudet AL. An initiation codon mutation in CD18 in association with the moderate phenotype of leukocyte adhesion deficiency. J Biol Chem. 1992;267:714–8.PubMed Sligh JE, Hurwitz MY, Zhu CM, Anderson DC, Beaudet AL. An initiation codon mutation in CD18 in association with the moderate phenotype of leukocyte adhesion deficiency. J Biol Chem. 1992;267:714–8.PubMed
27.
go back to reference Shah KM, Pratt EL, Al-Rahawan MM, Abraham RS. Novel combination of ITGB2 mutations causing leukocyte adhesion deficiency type 1 (LAD-1). J Pediatr Infect Dis. 2011;6:141–8. Shah KM, Pratt EL, Al-Rahawan MM, Abraham RS. Novel combination of ITGB2 mutations causing leukocyte adhesion deficiency type 1 (LAD-1). J Pediatr Infect Dis. 2011;6:141–8.
28.
go back to reference Khanduri U, Pulimood R, Sudarsanam A, Carman RH, Jadhav M, Pereira S. Glanzmann’s thrombasthenia. A review and report of 42 cases from south India. Thromb Haemost. 1981;46:717–21.PubMed Khanduri U, Pulimood R, Sudarsanam A, Carman RH, Jadhav M, Pereira S. Glanzmann’s thrombasthenia. A review and report of 42 cases from south India. Thromb Haemost. 1981;46:717–21.PubMed
29.
go back to reference Madkaikar M, Currimbhoy Z, Gupta M, Desai M, Rao M. Clinical profile of leukocyte adhesion deficiency type I. Indian Pediatr. 2012;49:43–5.CrossRefPubMed Madkaikar M, Currimbhoy Z, Gupta M, Desai M, Rao M. Clinical profile of leukocyte adhesion deficiency type I. Indian Pediatr. 2012;49:43–5.CrossRefPubMed
30.
go back to reference Qasim W, Cavazzana-Calvo M, Davies EG, et al. Allogeneic hematopoietic stem-cell transplantation for leukocyte adhesion deficiency. Pediatrics. 2009;123:836–40.CrossRefPubMedPubMedCentral Qasim W, Cavazzana-Calvo M, Davies EG, et al. Allogeneic hematopoietic stem-cell transplantation for leukocyte adhesion deficiency. Pediatrics. 2009;123:836–40.CrossRefPubMedPubMedCentral
Metadata
Title
Leukocyte Adhesion Deficiency-I: Clinical and Molecular Characterization in an Indian Population
Authors
Prashant Deshpande
Kotteeswari Kathirvel
Ansu Abu Alex
Anu Korula
Biju George
RV Shaji
Vikram Mathews
Publication date
01-08-2016
Publisher
Springer India
Published in
Indian Journal of Pediatrics / Issue 8/2016
Print ISSN: 0019-5456
Electronic ISSN: 0973-7693
DOI
https://doi.org/10.1007/s12098-016-2051-0

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