Development of Lymphoma in Autoimmune Lymphoproliferative Syndrome (ALPS) and its Relationship to Fas Gene Mutations

Department of Pathology and Laboratory Medicine, University of Groningen, Groningen, Groningen, Netherlands
Leukemia and Lymphoma (Impact Factor: 2.89). 04/2004; 45(3):423-31. DOI: 10.1080/10428190310001593166
Source: PubMed


Autoimmune Lymphoproliferative Syndrome (ALPS) is generally the result of a mutation in genes associated with apoptosis, like Fas, Fas ligand, Casp 8 and Casp 10. As a result, the normal homeostasis of T- and B-lymphocytes is disturbed and a proliferation of polyclonal T lymphocytes occurs. This leads to hepatosplenomegaly and lymphadenopathy and in most patients also to autoimmune phenomena like anemia and thrombocytopenia. The proliferating T cells are TCRalphabeta and/or TCRgammadelta positive but lack both CD4 and CD8. Hence they are termed double negative (DN) T cells. In addition, there is an increase of CD5 positive B cells. Individuals with germline mutations in the Fas gene have a high risk to develop non Hodgkin lymphomas (x 14) as well as Hodgkin lymphomas (x 51), in particular NLP Hodgkin lymphoma. Somatic mutations of Fas are frequently acquired during the normal germinal center reaction. Non Hodgkin lymphomas carry somatic mutations of the Fas gene in 11% and of the Casp 10 gene in 14.5% of the patients. In Hodgkin lymphomas, Fas mutations can be demonstrated in Reed-Sternberg cells in 10-20% of the patients. These data implicate a role for Fas-mediated apoptosis in preventing lymphomas. Inherited defects in receptor-mediated lymphocyte apoptosis represent a risk factor for lymphomas and somatic mutations of these genes may also play a role in the development and/or progression of lymphomas.

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    • "NLPHL represents a minor fraction of HL and derives from the neoplastic transformation of germinal centre B cells at the centroblastic stage. Familial NLPHL are rarely observed in immune competent subjects [34]–[37], but they are commonly seen in patients suffering from autoimmune lymphoproliferative syndrome (ALPS) [7], [8], a disorder of apoptosis in which the inability of lymphocytes to undergo programmed cell death leads to lymphadenopathy, hypersplenism, and autoimmune cytopenias increasing the risk of developing Hodgkin (HL) and non-Hodgkin lymphoma (NHL). "
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    ABSTRACT: Hermansky Pudlak type 2 syndrome (HPS2) is a rare autosomal recessive primary immune deficiency caused by mutations on β3A gene (AP3B1 gene). The defect results in the impairment of the adaptor protein 3 (AP-3) complex, responsible for protein sorting to secretory lysosomes leading to oculo-cutaneous albinism, bleeding disorders and immunodeficiency. We have studied peripheral blood and lymph node biopsies from two siblings affected by HPS2. Lymph node histology showed a nodular lymphocyte predominance type Hodgkin lymphoma (NLPHL) in both HPS2 siblings. By immunohistochemistry, CD8 T-cells from HPS2 NLPHL contained an increased amount of perforin (Prf) + suggesting a defect in the release of this granules-associated protein. By analyzing peripheral blood immune cells we found a significant reduction of circulating NKT cells and of CD56(bright)CD16(-) Natural Killer (NK) cells subset. Functionally, NK cells were defective in their cytotoxic activity against tumor cell lines including Hodgkin Lymphoma as well as in IFN-γ production. This defect was associated with increased baseline level of CD107a and CD63 at the surface level of unstimulated and IL-2-activated NK cells. In summary, these results suggest that a combined and profound defect of innate and adaptive effector cells might explain the susceptibility to infections and lymphoma in these HPS2 patients.
    PLoS ONE 11/2013; 8(11):e80131. DOI:10.1371/journal.pone.0080131 · 3.23 Impact Factor
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    • "In a study conducted on patients suffering from ALPS [45] (also known as Canale-Smith syndrome) the authors demonstrated that the percentage of DN T cells increased from 1% (observed in physiological conditions) to 40% [46]. These results together with other evidence [26] [27] [28] [29] suggest that the increased number of DN T cells may represent a sensitive test or biomarker to screen patients who should undergo testing for ALPS. In this regard it is interesting to mention that the analysis of DN T cell levels has been used to distinguish ALPS from other autoimmune disease such as Evans syndrome [27] or sarcoidosis [47]. "
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    ABSTRACT: Recent studies have shown that T cells are not just the latecomers in inflammation but might also play a key role in the early phase of this response. In this context, a number of T cell subsets including NKT cells, mucosal-associated invariant T cells and γ/δ T cells have been shown, together with classical innate immune cells, to contribute significantly to the development and establishment of acute and chronic inflammatory diseases. In this commentary we will focus our attention on a somewhat neglected class of T cells called CD3(+)CD4(-)CD8(-) double negative T cells and on their role in inflammation and autoimmunity. We will summarize the most recent views on their origin at the thymic and peripheral levels as well as their tissue localization in immune and non-lymphoid organs. We will then outline their potential pathogenic role in autoimmunity as well as their homeostatic role in suppressing excessive immune responses deleterious to the host. Finally, we will discuss the potential therapeutic benefits or disadvantages of targeting CD3(+)CD4(-)CD8(-) double negative T cells for the treatment of autoimmune disease. We hope that this overview will shed some light on the function of these immune cells and attract the interest of investigators aiming at the design of novel therapeutic approaches for the treatment of autoimmune and inflammatory conditions.
    Biochemical pharmacology 05/2011; 82(4):333-40. DOI:10.1016/j.bcp.2011.05.019 · 5.01 Impact Factor
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