Our study is aimed at analysing and comparing distinctive intracellular cytokines in patients with autoimmune thyroiditis associated or not with selected non-endocrine autoimmune diseases. A total GDC-0449 in vivo of 78 Caucasian patients agreed to participate in this study. The inclusion criteria were a definite diagnosis of HT associated or not with the most representative non-endocrine autoimmune diseases (chronic atrophic gastritis, CD, generalized vitiligo and Sjögren’s syndrome). Exclusion criteria

were: (a) the presence of anti-thyrotrophin (TSH)-receptor antibodies or ultrasonographic evidence of thyroid atrophy; (b) clinical history of hyperthyroidism; (c) evidence of infectious diseases in the last 3 months; (d) treatment with drugs known to interfere with the immune system, namely cytokines, interferon, corticosteroids, non-steroidal anti-inflammatory

drugs (NSAIDs), amiodarone, lithium; (e) pregnancy and lactation over the previous 6 months; and (f) presence of acute or chronic systemic diseases other than those included above. Ten patients were subsequently excluded because they took drugs for concomitant diseases, became pregnant or because they had simultaneous infectious diseases. Of the remaining 68 (55 female, 13 male; mean age = 40 ± 16 years), 33 met the criteria for isolated chronic lymphocytic thyroiditis (28 females, five males; mean age = 34 ± 13 years). The remaining 35 patients (27 females, eight males; mean age = 47 ± 16 years), besides chronic lymphocytic thyroiditis, also had chronic atrophic gastritis (n = 18; seven patients also with pernicious anaemia), AZD2014 purchase CD (n = 7), generalized vitiligo (n = 6) and Sjögren’s syndrome (n = 4). The study was conducted with written informed consent and as part of the diagnostic work-up of the patients involved, according to the local ethical rules and the guidelines in the

Declaration of Helsinki. RPMI-1640 supplemented with 25 mm Hepes buffer, 2 mm glutamine, 100 U/ml Sclareol penicillin, heat-inactivated fetal calf serum (FCS) and phosphate-buffered saline (PBS) Dulbecco’s medium without calcium and magnesium and sodium bicarbonate were purchased from Gibco (Grand Island, NY, USA). Fycoll Hypaque (Lymphoprep) density 1·077 ± 0·001 g/ml, osmolality 280 ± 15 mOsm, was from Axis-Shield (Oslo, Norway). Phorbol-12-myristate-13-acetate (PMA), ionomycin, monensin and digitonin were purchased from Sigma (St Louis, MO, USA). Paraformaldehyde (PFA) was from Merck (Darmstadt, Germany). Monoclonal antibodies (anti-CD4, anti-CD8, anti-CD2, anti-IL-2, anti-IL-4, anti-IFN-γ fluorescein isothiocyanate (FITC)-conjugate and anti-CD8 phycoerythrin (PE)-conjugate) and isotype-matched antibodies were purchased from IL-Coulter (Hialeah, FL, USA). Blood samples were sampled from all patients at the same time of day and processed immediately.

An alteration in the Treg cell population might correspond

to the diminishment of the tumour mass in patients with cancer and could therefore be a useful marker of the intensity of the selective suppression of the host immune system and also of the degree of radicalism of a procedure. Certainly, it is well known that in order for anti-cancer therapy to succeed the proper immune response against cancer cells must be restored. Furthermore, monitoring the level of selective immune system suppression during cancer therapy might yield information that would support a decision to supplement standard therapy by immunotherapy or to increase the degree of radicalism of the applied therapy. Method of study  We examined the Treg cell populations in the peripheral blood of a group of patients treated surgically for ovarian cancer. In each patient, selleck kinase inhibitor the peripheral blood samples were collected both prior to and 1 day after the surgical procedure, and then again 5 days after the procedure. The presence of regulatory T cells in the samples was analyzed by means of flow cytometry. Results  In our study, the percentages of FOXP3+ cells in the subpopulation of CD4+ T lymphocytes found in the peripheral blood of the patients before the surgical intervention were statistically

significantly higher than those observed in the peripheral blood of these same patients after the surgical procedure. Conclusion  It would seem that the alteration in the Treg cell Tofacitinib datasheet subpopulation could be a key factor in determining the status of the tumour microenvironment. Most likely, it could provide information about whether the proper level of anti-cancer immune response could be restored. The possibility of restoring the immune response may directly correspond to the degree of radicalism of the surgical intervention. “
“Like many other complex human disorders of unknown aetiology, autoimmune-mediated type 1 diabetes may Pazopanib cell line ultimately be controlled via a therapeutic approach that combines multiple agents, each with differing modes of action. The numerous advantages of such a strategy include the ability to minimize toxicities

and realize synergies to enhance and prolong efficacy. The recognition that combinations might offer far-reaching benefits, at a time when few single agents have yet proved themselves in well-powered trials, represents a significant challenge to our ability to conceive and implement rational treatment designs. As a first step in this process, the Immune Tolerance Network, in collaboration with the Juvenile Diabetes Research Foundation, convened a Type 1 Diabetes Combination Therapy Assessment Group, the recommendations of which are discussed in this Perspective paper. Type 1 diabetes (T1D), one of the most common autoimmune diseases, results from the progressive destruction of insulin-producing pancreatic β cells by CD4+ and CD8+ T cells.

As shown in Fig. 1B, 1 min after Ag addition an average of 11±1.4% of BMMCs interacted with Tregs. A low dose of Ag (1 ng/mL) did not significantly the change number of conjugates over time, while at higher Ag concentrations (10 and 100 ng/mL) the percentages of BMMCs making contacts with Tregs

steadily increased (from 12±3.1 to 23±3.2% with 10 ng/mL at 1 and 20 min respectively, and from 9±0.9 to 18±3.8% with 100 ng/mL at 1 and 20 min respectively). BMMCs are an in vitro model of immature or mucosal MC phenotype, while peritoneal MCs (PMCs) are mature tissue resident MCs with features of connective MC 21. To further support the crucial role of Tregs in limiting the MC degranulation response, we purified PMCs (Supporting Information Fig. S1) and evaluated conjugate formation Forskolin research buy in the presence of Tregs. Moreover, we extended our study to human samples performing experiments using human CD4+CD25+ Tregs and the human LAD2 MC line. As depicted in Fig. 1C, the CD4+CD25+ see more T cell population efficiently made contact with both BMMCs and PMCs and, interestingly, similar conjugate formations were observed using human MCs and CD4+CD25+ T cells. Percentages of MC–Treg contacts early after Ag addition were similar in both murine and human cell co-cultures (8±2.3, 12±3.9 and 8±2.9%

for BMMCs, PMCs and LAD2 respectively) and increased 20 min after FcεRI triggering (14±6.3, 20±3.8 and 18±5.2% for BMMCs, PMCs and LAD2, respectively) (Fig. 1D). MC degranulation was significantly reduced in both murine and human MC–Treg co-culture settings (Fig. 1E), confirming that the inhibitory effects on IgE/Ag-triggered MC response. These results illustrate the formation of cognate interactions between different MC types and CD4+CD25+ Tregs;

moreover, the unchanged Treg suppressive function provides unequivocal proof that these cell populations are capable of exhibiting functional responses when co-cultured. To determine whether the OX40L–OX40 axis could influence the dynamics of conjugation between BMMCs and Tregs, the percentage of BMMCs making contacts with WT or OX40-deficient (OX40−/−) Tregs over total BMMCs were quantified as described in the Materials and methods. As shown in Fig. 2A, after Ag addition the capacity 5-FU nmr of BMMCs to form conjugates with WT, but not with OX40−/−, Tregs increased at both 5 and 20 min of incubation. MC–Treg conjugates were monitored for 20 min and classified into three categories depending on the duration of their interaction. The majority of MC–Treg interactions were short-lived, but some cell–cell contacts lasted more than 15 min and, thus, were considered long-lasting interactions (Fig. 2B). In the presence of WT Tregs, BMMCs made 30% short, 48% of intermediate and 22% long-lasting interactions. When OX40−/− Tregs were used, short contact increased up to 42%, intermediate conjugates dropped to 30%, while the amount of long-lasting contacts remained almost similar to WT Tregs (28%).

We performed 5′ RACE using degenerate primers based on a conserved C domain amino acid sequence to isolate putative dromedary TCRG chain cDNA clones. A total of 20 cDNA clones were selected, and two groups of clones were identified which shared Afatinib concentration almost identical C region sequences (nucleotide identity of 89%), which were respectively named TCRGC2 and TCRGC1 (Supporting Information Table 1). A BLAST search showed that the clones shared significant identity with known TCR γ chains, the best match being with the TCR γ chain of artiodactyls (ruminants and pig). The complete

sequences of the C regions were assembled using cDNA clones from 3′ RACE. A comparison of the deduced amino acid sequence of the two assembled

C regions with sheep and human sequences, as well as the boundaries of their conserved extracellular domain (C-DOMAIN), connecting (CO), transmembrane (TM), and cytoplasmatic (CY) domains, is shown in Figure 1A. Considering the exon organization of the ovine and human C regions, we inferred that both the dromedary C regions keep a connecting region encoded by three different exons, as is observed in the sheep TCRGC2, SCH727965 chemical structure TCRGC4, and TCRGC6 genes [15] and in the polymorphic human TCRGC2 gene [2, 16]. The two cysteines involved in the intrachain disulfide bond (positions 23 and 104 according to the IMGT unique numbering [17]) and those involved in the interchain disulfide bond are conserved, as well as the lysine (Lys K) amino acid in the TM region required for interaction with CD3γ. Furthermore two TCRGV genes and two distinct TCRGJ genes were identified within the variable domain of the cDNA clones. The TCRGV genes were classified in two distinct TCRGV1 and TCRGV2 subgroups. Sequence comparison with the available database entries indicates a high level of similarity Racecadotril with the ovine TCRGV6-1 and pig TCRGV5-1 functional genes (Fig. 1B), whereas its most strictly related counterpart in human (the TCRGVA gene) is a pseudogene. Similarly, the TCRGV1 gene subgroup has the highest level of similarity with TCRGV genes of artiodactyls (ovine TCRGV9-1 and

pig TCRGV6-1) (Fig. 1B). The sequence analysis of the isolated cDNA clones suggests the presence of two TCRG cassettes. Dromedary lung DNA was purified to perform sequencing of the germline TCRG locus. Both genomic PCR and Genome Walker DNA walking strategies were used. The sequence was assembled from ten PCR products and three chomosome walking fragments and in most cases was derived from at least two independent products. A gap in the genomic sequence exists between TCRGJ1-1 and TCRGC1. However, we identified a partially assembled lama (Lama pacos) genomic scaffold (acc. ABRR01332756.1) similar to dromedary TCRG1 cassette (see Materials and Methods). We found out that another TCRGJ gene (TCRGJ1-2) is present downstream of TCRGJ1-1 in the lama genome.

The recognition of a patient with DBA who subsequently developed CVID lends support to our previous finding of a heterozygous mutation in the SBDS gene of SBDS in another CVID patient, suggesting that ribosome biogenesis defects are responsible for a subset of CVID. Genetic defects in the ribosomal translational machinery responsible for various bone marrow failure syndromes are recognized readily when they manifest in children, but diagnosing these in adults presenting with complex phenotypes and hypogammaglobulinaemia can be a challenge. In this perspective paper, we discuss our clinical experience in CVID patients with ribosomopathies, and

review the immunological abnormalities buy Sirolimus in other conditions associated with ribosomal

dysfunction. With genetic testing available for various bone marrow failure syndromes, our hypothesis that ribosomal abnormalities may be present in patients with CVID could be proved in future studies by testing for mutations in specific ribosomal genes. New knowledge might then be translated into novel therapeutic strategies for patients in this group of immunodeficiency disorders. Common variable immunodeficiency disorders (CVID) comprise a range of hypogammaglobulinaemias, for which a small number of genetic defects have been identified [1–3]. However, these account for only a small proportion of cases of CVID, and the majority of patients have no identified genetic cause. A number of bone marrow failure syndromes are now recognized to be due to defects in ribosome biogenesis with mutations in genes coding for ribosomal proteins. Various immunological abnormalities Selleck Bioactive Compound Library are evident in these syndromes and mafosfamide provide proof that failure of optimal ribosome function, ‘ribosomopathies’, can also affect cells of the immune system. These syndromes are heterogeneous in their clinical presentations: for example, patients with Shwachman–Diamond syndrome (SDS) with confirmed mutations in the SBDS gene (Chr7q11) may not have all the characteristic features of neutropenia, skeletal defects and pancreatic insufficiency [4]. There is emerging evidence

that loss of Shwachman–Bodian–Diamond syndrome (SBDS) protein affects haematopoeisis and numbers of circulating B lymphocytes [5]. Craniofacial malformation syndromes such as Treacher–Collins syndrome, caused by haploinsufficiency of the treacle protein, also affect the cells of the immune system [6], and a broader immunological defect has been described in the congenital anaemia of Diamond–Blackfan syndrome (Diamond–Blackfan anaemia: DBA) [7]. The 5q- syndrome, a somatically acquired deletion of chromosome 5q and a subtype of myelodysplastic syndrome, leads to haploinsufficiency of a ribosomal protein that is also implicated in DBA. The active eukaryotic ribosome, the site of protein synthesis, is composed of 40S and 60S subunits.

40 These results are consistent with our own, as CatG is known to have a chymotrysin-like activity,

although digestion patterns of other substrates by these Dabrafenib supplier two proteases are not always identical.38 The finding that cleavage of MHC II occurs after L is consistent with published data on CatG specificity, the preferred P1 amino acids for CatG cleavage being Y, F, R, L, and K.41,42 Both in vitro and ex vivo data initially suggested, but did not prove, that CatG might be involved in physiological MHC II turnover. The DR loop that harbours the cleavage site is physically close to the DM interaction site of DR, and a subset of adjacent mutations that impair DM interaction also confer resistance to CatG-mediated proteolysis. DM is known to stabilize empty Deforolimus molecular weight MHC II molecules against degradation during endosomal peptide exchange, and this protective effect might be attributable to protection of DM-associated empty DR molecules from CatG cleavage. We were unable to reproduce this effect with DM/DR complexes formed in vitro (data not shown), but this negative result might reflect the fact that these are reversible, non-covalent

complexes. Furthermore, the inverse relationships between changes in CatG activity and MHC II levels during immune cell activation were consistent with a role for CatG in MHC II turnover. Previous work has shown that CatG accumulates in endocytic compartments of primary APCs and contributes to endosomal processing of autoantigens,38,43 so its subcellular location would be compatible with participation of CatG in endosomal MHC II turnover. However, three independent experiments failed

to provide positive evidence that would implicate CatG in MHC II turnover in APCs. First, pharmacological inhibition of CatG for extended periods of time in primary human APCs failed to cause accumulation of HLA-DR molecules or of large degradation intermediates. In some preliminary Tolmetin experiments, we noticed that endogenous CatG activity appeared to cause DR degradation following detergent lysis of cells (data not shown); however, inclusion of the CatG inhibitor in the lysis buffer prevented this artifact, and this precaution was adopted in the experiments shown here. Similarly, genetic ablation of CatG in mice had no effect on steady-state levels of murine MHC II molecules. Collectively, our data suggest that CatG acts enzymatically upon detergent-solubilized, but not upon membrane-embedded native MHC II molecules. We considered two possible explanations for the lack of CatG cleavage in live APCs. One possibility is that the resistance of MHC II molecules to endosomal CatG cleavage reflected the neutral, rather than endosomal, pH optimum of CatG cleavage of MHC II.

Patients’ outcomes were reviewed for 2 years from the admission of acute coronary syndrome. Primary outcomes of the study included re-hospitalization for acute coronary syndrome and all- cause mortality. Results: Thienopyridines users experienced significantly more re-hospitalization for acute coronary syndrome than aspirin users (26.64% vs. 17.48%, P < 0.001), whereas adjusted hazard https://www.selleckchem.com/products/bay-57-1293.html ratio [HR] was 1.56 (95% confidence interval [CI]: 1.30 to 1.88)

and all cause of mortality adjusted HR was 1.15 (95% CI: 0.99 to 1.34). Conclusion: In this retrospective analysis, aspirin treatment appeared more effective than thienopyridines for secondary prevention of acute coronary syndrome and showed a non-significant trend towards lower all-cause mortality. LIN CHIH-CHING1,2, YANG WU-CHANG1,2 1Taipei Veterans General Hospital; 2National Yang Ming University Introduction: Elevated

plasma asymmetric dimethylarginine (ADMA) has been reported to be associated with restenosis after percutaneous transluminal angioplasty (PTA) of AVF in hemodialysis (HD) patients. Dimethylarginine dimethylaminohydrolase 1 (DDAH1) is the major enzyme eliminating ADMA, but the effect of genetic variations in DDAH1 on the outcome of vascular access after PTA in HD patients remained unknown. Methods: We assessed the association between polymorphisms in DDAH1 and vascular access outcome in 473 maintenance HD patients, who were prospectively followed up for one BMS-777607 solubility dmso year after PTA for vascular access dysfunction. Eleven single nucleotide polymorphisms (SNPs) in endothelial function related genes were analyzed and plasma ADMA levels were determined at baseline. Results: After adjustment of demographic,

access, and risk factors, individuals with high baseline plasma ADMA (>0.9 μM) levels had higher rates of re-intervention at 6 months after PTA (74% vs. 53%, p = 0.05). DDAH1 rs233112 was significantly associated with increased levels of plasma ADMA levels. Compared with individuals with rs233112 AA genotypes, individuals with rs233112 GA or GG genotypes had higher risks for re-intervention (58% vs. 45%, p = 0.003) after PTA at 6 months. ZD1839 In the same multivariate- adjusted model, the clinical factors predicting higher risk of re-intervention at 6 months include current smoker, graft access, and rs233112 GG+GA genotypes of DDAH1 gene (HR 2.302, 95% CI 1.557–3.407). Conclusion: Our study demonstrate that rs233112 GG+GA genotypes of DDAH1 gene predict early and frequent restenosis of vascular accesses after PTA in HD patients. SEONG LIM PAIK, CHUNG JENG YA, YING WU MING Tungs’ Taichung Metroharbour Hospital Introduction: Chronic inflammation in dialysis patients may cause malnutrition and progressive atherosclerotic CVD and available data suggest that pro-inflammatory cytokines play a central role.

The measurements were performed as described before [16]. Briefly, each patient exhaled FK506 concentration against the fixed expiratory resistance of 16 cm H2O, which resulted in a constant flow of 50 ml/s. A plateau of NO concentration in the exhaled air at the selected exhalation rate was automatically selected by the computer software according to the American Thoracic Society recommendations. The measurements were repeated three times and the mean value expressed as fraction of expired NO (FeNO) was used for analysis. Flow cytometry analysis.  Samples of EDTA anticoagulated venous blood for flow cytometry and cytokine analyses were collected before (T0), 6 h (T6) and 24 h (T24) after allergen challenge. Flow cytometry

analysis was performed on the whole-blood samples using combinations of the following labelled monoclonal antibodies anti-CD14 FITC or anti-CD14 PE, anti-CD16 FITC or anti-CD16 PE-Cy5 and anti-CCR4 PE (all from BD PharMingen, Erembodegen, Belgium) as described before [6]. Labelled, isotype-matched BYL719 antibodies were used as negative controls. After

30 min of incubation at room temperature, erythrocytes were lysed using FACS Lysing Solution (BD PharMingen). The remaining white cells were analysed using FACSCalibur cytometer (BD Immunocytometry Systems, San Jose, CA, USA) as described before [6]. Individual PBM subsets were given names according to the nomenclature proposed by Ziegler-Heitbrock et al. [7]. Immune assays.  Serum concentration of total (tIgE) and specific anti-Dp IgE PDK4 (sIgE) were evaluated using UniCap (Phadia, Uppsala, Sweden). Plasma concentrations of CCL2, CX3CL1 and CCL17 were evaluated using Quantikine ELISA kits (R&D Diagnostics, Minneapolis, MN, USA). Statistical analysis.  The results are expressed as mean with 95% confidence interval (95%CI). Statistical analysis was performed using anova test. Post hoc analysis was performed using Student’s t-test. A probability value of P < 0.05

was taken to indicate statistical significance. Linear correlation by Pearson was used to estimate correlations between studied parameters. Allergen challenge resulted in the development of significant bronchoconstriction in 22 [responders (Rs)] of 34 Dp-APs. Those 22 patients reported both rhinitis and asthma symptoms. In 12 Dp-APs, no asthmatic response could be demonstrated [non-responders (NRs)]. Those patients had never reported asthma symptoms before the study. The baseline clinical and immunologic characteristics of the studied patients are presented in Table 1. There was no difference in age and sex distribution between Rs, NRs and HCs. All Dp-APs had comparable levels of serum tIgE, baseline lung function results and FeNO. The greatest mean eosinophil count was seen in Rs (415 cells/mm3; 95%CI 295–534 cells/mm3) being significantly greater than in NRs (214 cells/mm3; 95%CI 143–321 cells/mm3; P = 0.

6B, do not always correlate well with the levels of Egr2 in normal thymocytes; notably, in population A, where Egr2 expression is lowest, there are substantial effects on Socs1 expression in Egr2f/fCD4Cre mice. We suggest that the regulation of Socs1 by Egr2 is biologically significant, as events previously documented as lying downstream of Socs1 signaling during selection were also affected in Egr2-deficient thymocytes. Egr2-deficient CD4+CD8lo cells were unable to correctly upregulate Bcl2 expression as would normally occur following resumption of cytokine

signaling 30, and this was linked to lowered levels of pStat5 and a reduced ability to survive in IL-7-supplemented medium. We note that survival might be further compromised by the loss of a small population of high-level expressors of IL-7R in Egr2-deficient CD4+CD8lo subsets. BVD-523 Regulation of Socs1 might also provide an explanation for the increase in numbers of CD8SP thymocytes in Egr2-Tg animals, as this fits well with the observations that in the absence of Socs1, CD8SP T-cell differentiation

is enhanced 33. It would be of great interest to determine whether gain of Socs1 is able to rescue this aspect of the Egr2-Tg phenotype. PARP inhibitor We and others have shown that following TCR ligation, both the MAPK and calcineurin signaling pathways are required for induction of Egr2

15, 22. The convergence of these pathways on Egr2 suggests it may lie at a crucial control point in the selection process. Previously, it has been suggested that the expression levels and activity of Egr proteins combine to modulate positive selection following TCR ligation 24. Where the signal is strong, as in the highest affinity TCR interactions with peptide-MHC, Egr2 and its relatives Egr1 and Egr3 are induced at high levels and are not the rate-limiting step in the selection process. However, where the TCR is weak enough for a thymocyte to be on the boundary between positive selection and death by neglect, increased amounts of Egr proteins permit positive selection to occur, and decreased amounts cause the cell to fail selection. Our data suggest PFKL an extension of this model whereby titration of the levels of Egr2 by TCR signal strength could perhaps modulate the cytokine-mediated survival signal by regulating the level of Socs1, thus fine-tuning the process of positive selection. Egr2-Tg mice were made by microinjection into oocytes of Sfi1-linearised pVAhCD2 plasmid 40 containing LoxP-flanked DsRed and Egr2 cDNA. Details of construct are available upon request. Other strains used have been previously published as follows: CD4Cre 27; Egr2f/f28 MHC-deficient mice 41, 42, Rag2−/−43, Rag1−/−44, TCR-β F5 45, TCR-β HY 46 and TCR-β OTII 47.

As the common clinical features of XLP are FIM, EBV-associated HLH and lymphoproliferative disorder [2, 3], we completed SH2D1A and XIAP gene sequencing in the patients with one or more of these symptoms in this study. Most XLP patients appear healthy prior to contracting EBV [16]. However, following infection, patients often develop T and B cell lymphoproliferation and secondary HLH [16, 17]. Using gene sequencing, we diagnosed five patients with XLP of the 21 male patients in our study with FIM, EBV-associated HLH or persistent EBV

viremia. The overall clinical phenotypes of the affected persons matched those previously reported. All of the five patients had symptoms of HLH and four tested positive for EBV-DNA. This finding indicated that EBV infection triggers HLH in patients with SH2D1A or XIAP deficiency. Although Patient 2 was EBV-DNA negative, we still consider HLH as triggered

GDC-973 by EBV infection based on the elevated atypical lymphocyte counts. Previous study reported that about 13 XLP patients showed hypogammaglobulinemia [18]. In our study, 1 patient with SH2D1A deficiency had lower IgG, IgA and IgM levels, especially IgG. The results indicate that the patient had hypogammaglobulinemia. All four patients evaluated for immunological function showed a low CD4/CD8 ratio, which may be associated with EBV infection. selleck kinase inhibitor In patients with XLP, disease onset is usually Astemizole at 2–5 years of age and is often triggered by EBV infection [16, 19]. Among the five patients in the study, the youngest one was only 1 month old at time of onset. It is different with the western world, maybe due to early encountering of the EBV infection. Although there is no precise epidemiological data of EBV infection, the age of onset is thought to vary widely, with developed countries having

higher ages at primary infection, most likely due to better hygienic conditions and other socioeconomic and demographic factors including household size and population density [20]. The result indicates that patients with SH2D1A or XIAP deficiency can show XLP associated symptoms at a very young age. Prior reports indicate that the prognosis for XLP is poor, with 70% of patients dying before the age of 10 and mortality nearing 96% for those with a history of EBV infection [2, 4, 5]. In our study, three patients had rapid disease progression and died. Only one patient received HSCT and is well. The prognosis observed in our study is therefore similar to previous studies. In summary, we report the clinical and genetic features of five Chinese patients with SH2D1A/XIAP deficiency in this study. For patients with severe EBV-associated HLH, our results indicate the need to consider the possibility of XLP. This work was supported by the National Natural Science Foundation of China (81172877, 81000260) and Shanghai Rising-Star Program (11QA1400700). All authors declare no conflict of interest.