Publications by authors named "Atar Lev"

Background: Hematopoietic stem cell transplantation (HSCT) is a curative treatment for infants with severe combined immunodeficiency (SCID). Different factors determine HSCT success and overall survival (OS). Specifically, prompt diagnosis of SCID, preferably through newborn screening (NBS), is critical.

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Genetic variants in Folliculin interacting protein 1 (FNIP1) were recently discovered as monogenic causes for immunodeficiency and cardiomyopathy, with only a few patients diagnosed thus far. In this study, we describe a patient harboring a novel genetic variant in FNIP1 causing immunodeficiency with cardiac involvement. Clinical and immunological workups were performed.

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Article Synopsis
  • Inborn errors of immunity (IEI) are diseases that affect how the immune system works, causing problems like getting sick easily or having allergies.
  • A 19-year-old girl with severe combined immunodeficiency (SCID) and a family history of similar issues had two genetic mutations that made her immune system not work right.
  • After getting a special treatment called HSCT, she developed serious autoimmune problems like lupus, and tests showed complicated genetic issues can exist in people from close families.
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  • CD4+ T cells are crucial for the immune system, but their exact function is not fully understood, particularly the role of the CD4 protein itself.
  • Researchers studied seven patients with a rare genetic condition causing CD4 deficiency, leading to various infections, and found that these individuals lacked CD4+ T cells but had alternative T cell populations that could still mount immune responses.
  • While the patients showed compensatory immune responses against many pathogens, CD4 remains essential for protection against specific infections like human papillomavirus and Whipple's disease.
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Mutations in proteasome β-subunits or their chaperone and regulatory proteins are associated with proteasome-associated autoinflammatory disorders (PRAAS). We studied six unrelated infants with three de novo heterozygous missense variants in PSMB10, encoding the proteasome β2i-subunit. Individuals presented with T-B-NK± severe combined immunodeficiency (SCID) and clinical features suggestive of Omenn syndrome, including diarrhea, alopecia, and desquamating erythematous rash.

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  • Mutations in T-cell receptor (TCR) signaling can lead to combined immunodeficiency (CID), highlighted by its effects on T-cell homeostasis and differentiation.
  • This study focuses on two cousins with CID caused by a novel LCK gene mutation, which results in a truncated protein affecting T-cell function.
  • The patients experienced early infections, showed reduced CD4 T-cell levels, and while TCR signaling was impaired, some mTOR signaling pathways remained active, allowing for limited differentiation of T-cells despite their dysfunctional performance.
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Purpose Of Review: Severe combined immune deficiency (SCID) is the most devastating genetic disease of the immune system with an unfavorable outcome unless diagnosed early in life. Newborn screening (NBS) programs play a crucial role in facilitating early diagnoses and timely interventions for affected infants.

Recent Findings: SCID marked the pioneering inborn error of immunity (IEI) to undergo NBS, a milestone achieved 15 years ago through the enumeration of T-cell receptor excision circles (TRECs) extracted from Guthrie cards.

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Purpose: Patients with X-linked agammaglobulinemia (XLA) are characterized by humoral impairment and are routinely treated with intravenous immunoglobulin (IVIG). In this study, we aimed to investigate the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in IVIG preparations harvested globally and evaluate the transfer of SARS-CoV-2 antibodies to the XLA patient.

Methods: A single-center, prospective cohort study was conducted in the period of November 2020 to November 2022.

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  • - Patients with primary immunodeficiency disorders (PIDs) often experience unique and severe skin infections due to their compromised immune systems, highlighting the challenges in diagnosis and treatment
  • - A study reviewed cases of eight children with PIDs who presented with atypical skin infections, noting their average diagnosis age and types of infections, which included serious cases like ulcerative-hemorrhagic varicella-zoster virus and resistant scabies
  • - The findings emphasize the importance of recognizing unusual infectious skin manifestations in PID patients, which can lead to critical treatment interventions and improved outcomes
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Severe combined immunodeficiency (SCID) is a group of disorders caused by mutations in genes involved in the process of lymphocyte maturation and function. CRISPR-Cas9 gene editing of the patient's own hematopoietic stem and progenitor cells (HSPCs) could provide a therapeutic alternative to allogeneic hematopoietic stem cell transplantation, the current gold standard for treatment of SCID. To eliminate the need for scarce patient samples, we engineered genotypes in healthy donor (HD)-derived CD34 HSPCs using CRISPR-Cas9/rAAV6 gene-editing, to model both SCID and the therapeutic outcomes of gene-editing therapies for SCID via multiplexed homology-directed repair (HDR).

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Background: Autosomal dominant hyper-IgE syndrome (AD-HIES) caused by dominant negative (DN) variants in the signal transducer and activator of transcription 3 gene () is characterized by recurrent Staphylococcal abscesses, severe eczema, chronic mucocutaneous candidiasis (CMC), and non-immunological facial and skeletal features.

Objectives: To describe our experience with the diagnosis and treatment of adult patients with AD-HIES induced by DN- variants.

Methods: The medical records of adult patients (>18 years) treated at the Allergy and Clinical Immunology Clinic of Hadassah Medical Center, Jerusalem, Israel, were retrospectively analyzed.

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  • * The child was diagnosed with diffuse large B cell lymphoma, and genetic analysis identified a novel homozygous mutation in the SLP76 gene, which is important for T cell signaling and linked to immunodeficiency disorders.
  • * Functional studies of T cells showed that this mutation impaired key signaling processes, suggesting that SLP76 deficiency contributes to severe EBV infections and should be recognized as a significant factor in related immunological conditions.
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Purpose: Receptor-interacting serine/threonine-protein kinase 1 RIPK1) is an important regulator of necroptosis and inflammatory responses. We present the clinical features, genetic analysis and immune work-up of two patients with infantile-onset inflammatory bowel disease (IBD) resulting from mutations.

Methods: Whole exome and Sanger sequencing was performed in two IBD patients.

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  • The study aimed to evaluate the immune response in infants exposed to anti-TNFα or azathioprine due to their mothers' inflammatory bowel disease, focusing on T and B cell distribution and function.
  • Conducted from 2014 to 2017, the research involved measuring anti-TNFα levels in cord blood and analyzing T-cell function and immunoglobulin levels in infants at 3 and 12 months.
  • Findings indicated that infants exposed to anti-TNFα had normal immune responses, with adequate B-cell counts and no severe infections, but further research with untreated controls is necessary for confirmation.
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Background: Hemophilia A (HA) therapy requires intravenous replacement infusions of factor (F) VIII concentrate. Inhibitors are high-affinity immunoglobulin G that are directed against FVIII and thereby render replacement therapy ineffective. This complication has significant prognostic implications.

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Patients with Wiskott-Aldrich syndrome (WAS) harbor mutations in the WAS gene and suffer from immunodeficiency, microthrombocytopenia, and eczema. T-cells play an important role in immune response in the skin and the γδT-cells have an important role in skin homeostasis. Since WAS patients often present with eczema, we wanted to examine whether the T-cell receptor gamma (TRG) repertoire of the γδT-cells is affected in these patients.

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Background: During the process of generating diverse T and B cell receptor (TCR and BCR, respectively) repertoires, double-strand DNA breaks are produced. Subsequently, these breaks are corrected by a complex system led by the non-homologous end-joining (NHEJ). Pathogenic variants in genes involved in this process, such as the gene, cause severe combined immunodeficiency syndrome (SCID) along with neurodevelopmental disease and sensitivity to ionizing radiation.

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The transcription factor GATA2 plays a key role in the survival and self-renewal of hematopoietic stem and progenitor cells. Autosomal dominant variants in cause a broad spectrum of heterogeneous phenotypes. Here, we present our experience with GATA2 deficiency in a retrospective multicenter analysis of computerized medical records of adult patients (age ≥18 years) treated between 2018 and 2022 at Shaare Zedek Medical Center in Jerusalem and Sheba Tel-Hashomer Medical Center in Ramat Gan, Israel.

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Article Synopsis
  • Newborn screening (NBS) programs for severe combined immunodeficiency (SCID) have significantly improved early diagnosis and outcomes for affected infants, making long-term follow-up essential.
  • In Israel, a 5-year analysis of the NBS program revealed a SCID incidence of 1:29,000 births and identified specific genetic defects in affected infants, with no missed diagnoses.
  • The study found a 91% survival rate following hematopoietic stem cell transplantation for SCID patients, supporting the case for global implementation of NBS, particularly in regions with high consanguinity.
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  • Diagnosis of primary complement deficiencies often goes unrecognized, leading to underdiagnosis and a lack of treatment in susceptible patients.
  • A retrospective study across two medical centers identified five pediatric patients with novel mutations in complement components C6-C8, linked to severe infections like meningitis.
  • Increased awareness of the signs of complement deficiencies can enable earlier diagnosis and treatment, particularly in cases of recurrent meningococcal infections or high rates of consanguinity.
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X-linked agammaglobulinemia (XLA) is caused by mutations in the Bruton tyrosine kinase) BTK) gene. Affected patients have severely reduced amounts of circulating B cells. Patients with atypical XLA may have residual circulating B cells, and there are few studies exploring these cells' repertoire.

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  • STAT1 heterozygous gain-of-function mutations lead to immune dysregulation and chronic mucocutaneous candidiasis, with emerging links to demodicosis.
  • A study analyzed five patients (mean age 11.11) from two Jewish families, all presenting with immune issues and demodicosis, revealing a novel STAT1 mutation in four cases.
  • Immune profiling indicated heightened STAT activation, reduced T cell responses, and specific antibody deficiency, suggesting demodicosis could signal underlying immune deficiencies; treatment involved topical ivermectin and metronidazole.
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Background: Cutaneous manifestations of dedicator of cytokinesis 8 gene (DOCK8) deficiency, a combined type of T and B cell immunodeficiency, previously designated as autosomal recessive hyper IgE syndrome, includes dermatitis and skin infections. There are limited treatment options for dermatitis related to the syndrome.

Objective: To describe a cohort of patients with DOCK8 deficiency with a focus on the treatment of their cutaneous manifestations.

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Genetic diagnostic tools including whole-exome sequencing (WES) have advanced our understanding in human diseases and become common practice in diagnosing patients with suspected primary immune deficiencies. Establishing a genetic diagnosis is of paramount importance for tailoring adequate therapeutic regimens, including identifying the need for hematopoietic stem cell transplantation (HSCT) and genetic-based therapies. Here, we genetically studied two adult patients who were clinically diagnosed during infancy with severe combined immune deficiency (SCID).

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Immunoglobulin replacement therapy is a mainstay therapy for patients with primary immunodeficiency (PID). The content of these preparations was studied extensively. Nevertheless, data regarding the effective specific antibodies content (especially in the nadir period), and, in different groups of PID patients is limited.

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