Publications by authors named "Pamela P Lee"

Up to 70% of patients with Wiskott-Aldrich syndrome (WAS) develop autoimmune and inflammatory manifestations. Dysregulation of interleukin 1 (IL-1) may be involved in their pathogenesis, yet there is little evidence on treatment with anti-IL-1 agents in these patients. We conducted a multicenter retrospective analysis of 9 patients with WAS treated with anti-IL-1 agents (anakinra or canakinumab).

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In this report, we describe a case of a 5-year-old girl with poor growth and unresolving pneumonia. Bronchoscopy showed numerous endobronchial mucosal nodules, consisting of dense lymphoid infiltrates. Bacterial culture of the nodule biopsy suggested endobronchial actinomycosis.

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Objectives: A partnership model in interprofessional education (IPE) is important in promoting a sense of global citizenship while preparing students for cross-sector problem-solving. However, the literature remains scant in providing useful guidance for the development of an IPE programme co-implemented by external partners. In this pioneering study, we describe the processes of forging global partnerships in co-implementing IPE and evaluate the programme in light of the preliminary data available.

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Background: Chronic granulomatous disease (CGD) is an inborn error of immunity (IEI) disorder that results from defects in the respiratory burst activity in phagocytes, leading to the inability to kill bacterial and fungal microorganisms. CGD patients usually have a high incidence of morbidity such as infections and autoinflammatory diseases and a high mortality rate. Allogeneic bone marrow transplantation (BMT) is the only definitive cure for patients who suffer from CGD.

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To address inborn errors of immunity (IEI) which were underdiagnosed in resource-limited regions, our centre developed and offered free genetic testing for the most common IEI by Sanger sequencing (SS) since 2001. With the establishment of The Asian Primary Immunodeficiency (APID) Network in 2009, the awareness and definitive diagnosis of IEI were further improved with collaboration among centres caring for IEI patients from East and Southeast Asia. We also started to use whole exome sequencing (WES) for undiagnosed cases and further extended our collaboration with centres from South Asia and Africa.

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Background: Many syndromes are associated with exaggerated inflammation. Children with hyperinflammatory syndromes often present with vague and non-specific symptoms that pose diagnostic and management challenges. The recent literature seems biased towards referring these syndromes only to the multisystem inflammatory syndrome in children (MIS-C) that is associated with COVID-19.

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Article Synopsis
  • Chronic granulomatous disease (CGD) is a genetic immune disorder leading to frequent infections, inherited in either X-linked or autosomal recessive forms, and this study explores the differences in symptoms (phenotypes) between these two forms using Human Phenotype Ontology (HPO) terms.
  • Data from 90 genetically diagnosed CGD patients from Asia and Africa were analyzed to compare the onset and types of infections experienced by X-linked (XL) and autosomal recessive (AR) patients.
  • Findings revealed that XL-CGD patients tend to have earlier onset and more severe infections, with specific symptoms like perianal abscess and BCGitis being more common, highlighting the need for distinguishing features for clinical diagnosis.
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is an important thermally dimorphic pathogen causing disseminated mycoses in immunocompromised individuals in southeast Asia. Previous studies have suggested that NLRP3 inflammasome plays a critical role in antifungal immunity. However, the mechanism underlying the role of NLRP3 inflammasome activation in host defense against remains unclear.

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The SARS-CoV-2 infection causes severe immune disruption. However, it is unclear if disrupted immune regulation still exists and pertains in recovered COVID-19 patients. In our study, we have characterized the immune phenotype of B cells from 15 recovered COVID-19 patients, and found that healthy controls and recovered patients had similar B-cell populations before and after BCR stimulation, but the frequencies of PBC in patients were significantly increased when compared to healthy controls before stimulation.

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Objectives: Meningitis in neonates and young infants leads to significant morbidity and mortality worldwide. This study aimed to investigate pathogens, antibiotic resistance and secular change of incidence in Hong Kong.

Methods: A retrospective search was performed on meningitis in neonates and infants aged <3 months in three Hong Kong public hospitals from 2004 to 2019.

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Article Synopsis
  • - The study focuses on Wiskott Aldrich syndrome (WAS), a condition that causes bleeding, infections, eczema, autoimmune issues, and cancer, and it emphasizes the increased recognition and diagnostics of WAS in India over the last decade across multiple centers.
  • - Data from six primary immunodeficiency disease centers were compiled, analyzing clinical details of 108 patients with WAS, revealing symptoms such as bleeding (92.6%), infections (84.2%), eczema (78.9%), and autoimmune manifestations (40%).
  • - Genetic analysis identified 47 variants in 67 cases, with the most common being nonsense and missense mutations; treatment included prophylactic intravenous immunoglobulin for 52 patients and hematopoietic stem cell
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Background: There is paucity of literature on XLA from developing countries. Herein we report the clinical and molecular profile and outcome in a multicenter cohort of patients with XLA from India.

Methods: Data on XLA from all regional centers supported by the Foundation for Primary Immunodeficiency Diseases (FPID), USA and other institutions providing care to patients with PIDs were collated.

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Treatment of life-threatening Epstein-Barr virus (EBV)-associated tumors remains a great challenge, especially for patients with relapsed or refractory disease. Here, we found that exosomes derived from phosphoantigen-expanded Vδ2-T cells (Vδ2-T-Exos) contained death-inducing ligands (FasL and TRAIL), an activating receptor for natural killer (NK) cells (NKG2D), immunostimulatory ligands (CD80 and CD86), and antigen-presenting molecules (MHC class I and II). Vδ2-T-Exos targeted and efficiently killed EBV-associated tumor cells through FasL and TRAIL pathways and promoted EBV antigen-specific CD4 and CD8 T cell expansion.

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Article Synopsis
  • - The Asia Pacific Society for Immunodeficiencies (APSID) has organized nine training schools over five years to address varying primary immunodeficiency (PID) care needs for early-career doctors across the Asia Pacific region.
  • - A study examined 427 abstracts from these schools, finding that factors like socio-economic development (measured by the Human Development Index or HDI) significantly affected the availability of essential immunologic and genetic tests, as well as the focus of learning topics.
  • - APSID identified specific strategies tailored to different HDI groups in order to enhance PID care and education in its member countries/regions based on the unique resource and training needs observed.
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With this issue we begin print publishing the responses received in our call for Medical Education Adaptations: Lessons learned from educators' experiences rapidly transforming practice on account of COVID‐19 related disruption.

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is an AIDS-defining infection in Southeast Asia and is associated with high mortality. It is rare in non-immunosuppressed individuals, especially children. Little is known about host immune response and genetic susceptibility to this endemic fungus.

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Wiskott-Aldrich syndrome (WAS) is a form of primary immunodeficiency (PIDs) resulting from mutations of the gene that encodes Wiskott-Aldrich syndrome protein (WASp). WASp is the first identified and most widely studied protein belonging to the actin nucleation-promoting factor family and plays significant role in integrating and transforming signals from critical receptors on the cell surface to actin remodeling. WASp functions in immune defense and homeostasis through the regulation of actin cytoskeleton-dependent cellular processes as well as processes uncoupled with actin polymerization like nuclear transcription programs.

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Background: Drug allergy, or drug hypersensitivity, is a potentially fatal disorder, and patients labeled with drug allergies have restricted access to first-line treatments. Full knowledge of the characteristics associated with drug allergies and severe reactions during allergy evaluation is beneficial for appropriate risk stratification.

Objective: We sought to determine whether certain clinical characteristics are associated with drug allergies in Chinese children.

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Background: X-linked agammaglobulinemia (XLA) is a primary immunodeficiency caused by Bruton's tyrosine kinase () mutation. Patients are susceptible to severe enterovirus infections. The underlying mechanism remains unknown.

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Dysregulation of autophagy and inflammasome activity contributes to the development of auto-inflammatory diseases. Emerging evidence highlights the importance of the actin cytoskeleton in modulating inflammatory responses. Here we show that deficiency of Wiskott-Aldrich syndrome protein (WASp), which signals to the actin cytoskeleton, modulates autophagy and inflammasome function.

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Article Synopsis
  • Severe Combined Immunodeficiency (SCID) is life-threatening and requires timely treatment, often delayed due to lack of newborn screening; family history of infant deaths related to SCID contributes to quicker diagnoses.
  • In a study of 147 SCID patients, 94 had genetic diagnoses, revealing 88 different gene mutations, with an average diagnosis age of 4 months and a delay of 2 months in identification.
  • Family history led to earlier presentations and diagnoses, while infections like candidiasis were common but resulted in later diagnosis times; clinicians often missed the significance of family history in clinical assessments.*
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The global burden of fungal diseases has been increasing, as a result of the expanding number of susceptible individuals including people living with human immunodeficiency virus (HIV), hematopoietic stem cell or organ transplant recipients, patients with malignancies or immunological conditions receiving immunosuppressive treatment, premature neonates, and the elderly. Opportunistic fungal pathogens such as , and are distributed worldwide and constitute the majority of invasive fungal infections (IFIs). Dimorphic fungi such as spp.

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Background: Epigenetic variants have been shown in recent studies to be important contributors to the pathogenesis of systemic lupus erythematosus (SLE). Here, we report a 2-step study of discovery followed by replication to identify DNA methylation alterations associated with SLE in a Chinese population. Using a genome-wide DNA methylation microarray, the Illumina Infinium HumanMethylation450 BeadChip, we compared the methylation levels of CpG sites in DNA extracted from white blood cells from 12 female Chinese SLE patients and 10 healthy female controls.

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Twenty percent of children with immune thrombocytopenia (ITP) develop a chronic course where treatment strategy is less established. Cyclosporin A (CSA) has been shown to be effective in small series of children with chronic ITP and might reduce the need for chronic steroid therapy and/or splenectomy. We reviewed consecutive patients below 18 years old with persistent or chronic ITP treated with CSA in our unit between January 1998 and June 2015.

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