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文献概要

今月の主題 免疫不全症候群と遺伝子異常 各疾患の遺伝子異常,診断と治療

先天性好中球減少症

著者: 岡田賢1 小林正夫2

所属機関: 1広島大学病院小児科 2広島大学大学院医歯薬学総合研究科小児科学

ページ範囲:P.587 - P.592

 先天性好中球減少症は慢性好中球減少,前骨髄球~骨髄球の段階での成熟障害を臨床的特徴とし,生後早期から重症細菌感染症を反復する先天性免疫不全症である.近年,種々の責任遺伝子が同定され,本症の分子レベルでの病因が明らかとなりつつある.本疾患では,好中球エラスターゼの責任遺伝子ELA2の異常を高頻度に認めることが知られていたが,2007年にHAX1が新規の責任遺伝子として報告された.われわれのわが国における患者解析では,ELA2変異が約70%に,HAX1変異が約20%に同定された.さらに興味深いことにHAX1変異を有する患者では,好中球減少症以外の症状として神経学的異常が認められることが特徴的であった.本稿では,先天性好中球減少症の最近の知見を概説する.

参考文献

1) Horwitz MS, Duan Z, Korkmaz B, et al:Neutrophil elastase in cyclic and severe congenital neutropenia. Blood 109:1817-1824, 2007
2) Klein C, Grudzien M, Appaswamy G, et al:HAX1 deficiency causes autosomal recessive severe congenital neutropenia(Kostmann disease). Nat Genet 39:86-92, 2007
3) Horwitz M, Benson KF, Person RE, et al:Mutations in ELA2, encoding neutrophil elastase, define a 21-day biological clock in cyclic haematopoiesis. Nat Genet 23:433-436, 1999
4) Dale DC, Person RE, Bolyard AA, et al:Mutations in the gene encoding neutrophil elastase in congenital and cyclic neutropenia. Blood 96:2317-2322, 2000
5) Benson KF, Li FQ, Person RE, et al:Mutations associated with neutropenia in dogs and humans disrupt intracellular transport of neutrophil elastase. Nat Genet 35:90-96, 2003
6) Köllner I, Sodeik B, Schreek S, et al:Mutations in neutrophil elastase causing congenital neutropenia lead to cytoplasmic protein accumulation and induction of the unfolded protein response. Blood 108:493-500, 2006
7) Grenda DS, Murakami M, Ghatak J, et al:Mutations of the ELA2 gene found in patients with severe congenital neutropenia induce the unfolded protein response and cellular apoptosis. Blood 110:4179-4187, 2007
8) Salipante SJ, Benson KF, Luty J, et al:Double de novo mutations of ELA2 in cyclic and severe congenital neutropenia. Hum Mutat 28:874-881, 2007
9) Belaaouaj A, McCarthy R, Baumann M, et al:Mice lacking neutrophil elastase reveal impaired host defense against gram negative bacterial sepsis. Nat Med 4:615-618, 1998
10) Grenda DS, Johnson SE, Mayer JR, et al:Mice expressing a neutrophil elastase mutation derived from patients with severe congenital neutropenia have normal granulopoiesis. Blood 100:3221-3228, 2002
11) Ishikawa N, Okada S, Miki M, et al:Neurodevelopmental abnormalities associated with severe congenital neutropenia due to the R86X mutation in the HAX1 gene. J Med Genet(in press)
12) Matsubara K, Imai K, Okada S, et al:Severe developmental delay and epilepsy in a Japanese patient with severe congenital neutropenia due to HAX1 deficiency. Haematologica 92:e123-125, 2007
13) Germeshausen M, Grudzien M, Zeidler C, et al:Novel HAX1 mutations in patients with severe congenital neutropenia reveal isoform-dependent genotype-phenotype associations. Blood 111:4954-4957, 2008
14) Chao JR, Parganas E, Boyd K, et al:Hax1-mediated processing of HtrA2 by Parl allows survival of lymphocytes and neurons. Nature 452:98-102, 2008
15) Bernini JC:Diagnosis and management of chronic neutropenia during childhood. Pediatr Clin North Am 43:773-792, 1996
16) Dale DC, Cottle TE, Fier CJ, et al:Severe chronic neutropenia:treatment and follow-up of patients in the Severe Chronic Neutropenia International Registry. Am J Hematol 72:82-93, 2003
17) Thachil J, Caswell M, Bolton-Maggs PH, et al:Non-myeloablative transplantation for severe congenital neutropenia. Pediatr Blood Cancer 50:920-921, 2008

掲載雑誌情報

出版社:株式会社医学書院

電子版ISSN:1882-1367

印刷版ISSN:0485-1420

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