First use of thymus transplantation therapy for FOXN1 deficiency (nude/SCID): a report of 2 cases

ML Markert, JG Marques, B Neven… - Blood, The Journal …, 2011 - ashpublications.org
ML Markert, JG Marques, B Neven, BH Devlin, EA McCarthy, IK Chinn, AS Albuquerque…
Blood, The Journal of the American Society of Hematology, 2011ashpublications.org
FOXN1 deficiency is a primary immunodeficiency characterized by athymia, alopecia totalis,
and nail dystrophy. Two infants with FOXN1 deficiency were transplanted with cultured
postnatal thymus tissue. Subject 1 presented with disseminated Bacillus Calmette-Guérin
infection and oligoclonal T cells with no naive markers. Subject 2 had respiratory failure,
human herpes virus 6 infection, cytopenias, and no circulating T cells. The subjects were
given thymus transplants at 14 and 9 months of life, respectively. Subject 1 received …
Abstract
FOXN1 deficiency is a primary immunodeficiency characterized by athymia, alopecia totalis, and nail dystrophy. Two infants with FOXN1 deficiency were transplanted with cultured postnatal thymus tissue. Subject 1 presented with disseminated Bacillus Calmette-Guérin infection and oligoclonal T cells with no naive markers. Subject 2 had respiratory failure, human herpes virus 6 infection, cytopenias, and no circulating T cells. The subjects were given thymus transplants at 14 and 9 months of life, respectively. Subject 1 received immunosuppression before and for 10 months after transplantation. With follow up of 4.9 and 2.9 years, subjects 1 and 2 are well without infectious complications. The pretransplantation mycobacterial disease in subject 1 and cytopenias in subject 2 resolved. Subject 2 developed autoimmune thyroid disease 1.6 years after transplantation. Both subjects developed functional immunity. Subjects 1 and 2 have 1053/mm3 and 1232/mm3 CD3+ cells, 647/mm3 and 868/mm3 CD4+ T cells, 213/mm3 and 425/mm3 naive CD4+ T cells, and 10 200 and 5700 T-cell receptor rearrangement excision circles per 100 000 CD3+ cells, respectively. They have normal CD4 T-cell receptor β variable repertoires. Both subjects developed antigen-specific proliferative responses and have discon-tinued immunoglobulin replacement. In summary, thymus transplantation led to T-cell reconstitution and function in these FOXN1 deficient infants.
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