European Society for Immunodeficiencies guidelines for the management of patients with congenital athymia.

J Allergy Clin Immunol

Department of Immunology and Gene Therapy, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; Infection Immunity and Inflammation Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.

Published: December 2024

AI Article Synopsis

  • Congenital athymia is a serious condition that affects the immune system and makes babies very sick because their thymus (an important organ for immunity) doesn't work properly.
  • Babies with this condition are very vulnerable to infections and sometimes have other health issues.
  • The best treatment is a special surgery called thymus transplantation, and catching this condition early helps kids stay healthier.

Article Abstract

Congenital athymia is a life-limiting disorder due to rare inborn errors of immunity causing impaired thymus organogenesis or abnormal thymic stromal cell development and function. Athymic infants have a T-lymphocyte-negative, B-lymphocyte-positive, natural killer cell-positive immunophenotype with profound T-lymphocyte deficiency and are susceptible to severe infections and autoimmunity. Patients variably display syndromic features. Expanding access to newborn screening for severe combined immunodeficiency and T lymphocytopenia and broad genetic testing, including next-generation sequencing technologies, increasingly facilitate their timely identification. The recommended first-line treatment is allogeneic thymus transplantation, which is a specialized procedure available in Europe and the United States. Outcomes for athymic patients are best with early diagnosis and thymus transplantation before the development of infectious and inflammatory complications. These guidelines on behalf of the European Society for Immunodeficiencies provide a comprehensive review for clinicians who manage patients with inborn thymic stromal cell defects; they offer clinical practice recommendations focused on the diagnosis, investigation, risk stratification, and management of congenital athymia with the aim of improving patient outcomes.

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http://dx.doi.org/10.1016/j.jaci.2024.07.031DOI Listing

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European Society for Immunodeficiencies guidelines for the management of patients with congenital athymia.

J Allergy Clin Immunol

December 2024

Department of Immunology and Gene Therapy, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; Infection Immunity and Inflammation Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.

Article Synopsis
  • Congenital athymia is a serious condition that affects the immune system and makes babies very sick because their thymus (an important organ for immunity) doesn't work properly.
  • Babies with this condition are very vulnerable to infections and sometimes have other health issues.
  • The best treatment is a special surgery called thymus transplantation, and catching this condition early helps kids stay healthier.
View Article and Find Full Text PDF
Article Synopsis
  • - Congenital athymia is a rare condition affecting T-lymphocyte levels, requiring thymus transplantation, and is often detected early through newborn screening for severe combined immunodeficiency (SCID).
  • - Parents of infants identified with suspected athymia expressed that they were not informed of this diagnosis until weeks after initial screening results, highlighting a gap in timely communication and information access during the diagnostic process.
  • - A proposal was made for a roadmap that provides easily understandable, real-time information for parents, aiming to enhance their journey through diagnosis and potentially applicable to other rare diseases, emphasizing the importance of parental involvement and public engagement in healthcare.
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Primary and secondary defects of the thymus.

Immunol Rev

March 2024

Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.

The thymus is the primary site of T-cell development, enabling generation, and selection of a diverse repertoire of T cells that recognize non-self, whilst remaining tolerant to self- antigens. Severe congenital disorders of thymic development (athymia) can be fatal if left untreated due to infections, and thymic tissue implantation is the only cure. While newborn screening for severe combined immune deficiency has allowed improved detection at birth of congenital athymia, thymic disorders acquired later in life are still underrecognized and assessing the quality of thymic function in such conditions remains a challenge.

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