Skip to main content

Advertisement

Log in

Successful cord blood transplantation for a CHARGE syndrome with CHD7 mutation showing DiGeorge sequence including hypoparathyroidism

  • Original Paper
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

It is rare that coloboma, heart anomalies, choanal atresia, retarded growth and development, and genital and ear anomalies (CHARGE) syndrome patients have DiGeorge sequence showing severe immunodeficiency due to the defect of the thymus. Although the only treatment to achieve immunological recovery for these patients in countries where thymic transplantation is not ethically approved would be hematopoietic cell transplantation, long-term survival has not been obtained in most patients. On the other hand, it is still not clarified whether hypoparathyroidism is one of the manifestations of CHARGE syndrome. We observed a CHARGE syndrome patient with chromodomain helicase DNA-binding protein 7 mutation showing DiGeorge sequence including the defect of T cells accompanied with the aplasia of the thymus, severe hypoparathyroidism, and conotruncal cardiac anomaly. He received unrelated cord blood transplantation without conditioning at 4 months of age. Recovery of T cell number and of proliferative response against mitogens was achieved by peripheral expansion of mature T cells in cord blood without thymic output. Although he is still suffering from severe hypoparathyroidism, he is alive without serious infections for 10 months.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

CHD7:

Chromodomain helicase DNA-binding protein 7

CBT:

Cord blood transplantation

TCR:

T cell receptor

PHA:

Phytohemagglutinin

Con A:

Concanavalin A

ABR:

Auditory brainstem response

GVHD:

Graft versus host disease

References

  1. Aramaki M, Udaka T, Kosaki R et al (2006) Phenotypic spectrum of CHARGE syndrome with CHD7 mutations. J Pediatr 148(3):410–414

    Article  CAS  PubMed  Google Scholar 

  2. Aramaki M, Udaka T, Torii C et al (2006) Screening for CHARGE syndrome mutations in the CHD7 gene using denaturing high-performance liquid chromatography. Genet Test 10(4):244–251

    Article  CAS  PubMed  Google Scholar 

  3. Blake KD, Davenport SL, Hall BD et al (1998) CHARGE association: an update and review for the primary pediatrician. Clin Pediatr (Phila) 37(3):159–173

    Article  CAS  Google Scholar 

  4. Brock KE, Mathiason MA, Rooney BL et al (2003) Quantitative analysis of limb anomalies in CHARGE syndrome: correlation with diagnosis and characteristic CHARGE anomalies. Am J Med Genet A 123A(1):111–121

    PubMed  Google Scholar 

  5. Brown JA, Boussiotis VA (2008) Umbilical cord blood transplantation: basic biology and clinical challenges to immune reconstitution. Clin Immunol 127(3):286–297

    Article  CAS  PubMed  Google Scholar 

  6. D’Arena G, Musto P, Cascavilla N et al (1998) Flow cytometric characterization of human umbilical cord blood lymphocytes: immunophenotypic features. Haematologica 83(3):197–203

    PubMed  Google Scholar 

  7. Devriendt K, Swillen A, Fryns JP (1998) Deletion in chromosome region 22q11 in a child with CHARGE association. Clin Genet 53(5):408–410

    Article  CAS  PubMed  Google Scholar 

  8. Gennery AR, Slatter MA, Rice J et al (2008) Mutations in CHD7 in patients with CHARGE syndrome cause T-B + natural killer cell + severe combined immune deficiency and may cause Omenn-like syndrome. Clin Exp Immunol 153(1):75–80

    Article  CAS  PubMed  Google Scholar 

  9. Günther T, Chen ZF, Kim J et al (2000) Genetic ablation of parathyroid glands reveals another source of parathyroid hormone. Nature 406(6792):199–203

    Article  PubMed  Google Scholar 

  10. Jyonouchi S, McDonald-McGinn DM, Bale S et al (2009) CHARGE (coloboma, heart defect, atresia choanae, retarded growth and development, genital hypoplasia, ear anomalies/deafness) syndrome and chromosome 22q11.2 deletion syndrome: a comparison of immunologic and nonimmunologic phenotypic features. Pediatrics 123(5):e871–e877

    Article  PubMed  Google Scholar 

  11. Komanduri KV, St John LS, de Lima M et al (2007) Delayed immune reconstitution after cord blood transplantation is characterized by impaired thymopoiesis and late memory T-cell skewing. Blood 110(13):4543–4551

    Article  CAS  PubMed  Google Scholar 

  12. Lalani SR, Safiullah AM, Fernbach SD et al (2006) Spectrum of CHD7 mutations in 110 individuals with CHARGE syndrome and genotype–phenotype correlation. Am J Hum Genet 78(2):303–314

    Article  CAS  PubMed  Google Scholar 

  13. Land MH, Garcia-Lloret MI, Borzy MS et al (2007) Long-term results of bone marrow transplantation in complete DiGeorge syndrome. J Allergy Clin Immunol 120(4):908–915

    Article  CAS  PubMed  Google Scholar 

  14. Markert ML (2008) Treatment of infants with complete DiGeorge anomaly. J Allergy Clin Immunol 121(4):1063–1064

    Article  PubMed  Google Scholar 

  15. Markert ML, Devlin BH, Alexieff MJ et al (2007) Review of 54 patients with complete DiGeorge anomaly enrolled in protocols for thymus transplantation: outcome of 44 consecutive transplants. Blood 109(10):4539–4547

    Article  CAS  PubMed  Google Scholar 

  16. Markert ML, Hummell DS, Rosenblatt HM et al (1998) Complete DiGeorge syndrome: persistence of profound immunodeficiency. J Pediatr 132(1):15–21

    Article  CAS  PubMed  Google Scholar 

  17. Meinecke P, Polke A, Schmiegelow P (1989) Limb anomalies in the CHARGE association. J Med Genet 26(3):202–203

    Article  CAS  PubMed  Google Scholar 

  18. Ohtsuka Y, Shimizu T, Nishizawa K et al (2004) Successful engraftment and decrease of cytomegalovirus load after cord blood stem cell transplantation in a patient with DiGeorge syndrome. Eur J Pediatr 163(12):747–748

    Article  PubMed  Google Scholar 

  19. Prasad C, Quackenbush EJ, Whiteman D et al (1997) Limb anomalies in DiGeorge and CHARGE syndromes. Am J Med Genet 68(2):179–181

    Article  CAS  PubMed  Google Scholar 

  20. Ryan AK, Goodship JA, Wilson DI et al (1997) Spectrum of clinical features associated with interstitial chromosome 22q11 deletions: a European collaborative study. J Med Genet 34(10):798–804

    Article  CAS  PubMed  Google Scholar 

  21. Sanka M, Tangsinmankong N, Loscalzo M et al (2007) Complete DiGeorge syndrome associated with CHD7 mutation. J Allergy Clin Immunol 120(4):952–954

    Article  CAS  PubMed  Google Scholar 

  22. Sanlaville D, Etchevers HC, Gonzales M et al (2006) Phenotypic spectrum of CHARGE syndrome in fetuses with CHD7 truncating mutations correlates with expression during human development. J Med Genet 43(3):211–217

    Article  CAS  PubMed  Google Scholar 

  23. Sullivan KE (2004) The clinical, immunological, and molecular spectrum of chromosome 22q11.2 deletion syndrome and DiGeorge syndrome. Curr Opin Allergy Clin Immunol 4(6):505–512

    Article  PubMed  Google Scholar 

  24. Van de Laar I, Dooijes D, Hoefsloot L et al (2007) Limb anomalies in patients with CHARGE syndrome: an expansion of the phenotype. Am J Med Genet A 143A(22):2712–2715

    Article  PubMed  CAS  Google Scholar 

  25. Vissers LE, van Ravenswaaij CM, Admiraal R et al (2004) Mutations in a new member of the chromodomain gene family cause CHARGE syndrome. Nat Genet 36(9):955–957

    Article  CAS  PubMed  Google Scholar 

  26. Vrisekoop N, den Braber I, de Boer AB et al (2008) Sparse production but preferential incorporation of recently produced naive T cells in the human peripheral pool. Proc Natl Acad Sci USA 105(16):6115–6120

    Article  CAS  PubMed  Google Scholar 

  27. Williams MS (2005) Speculations on the pathogenesis of CHARGE syndrome. Am J Med Genet A 133A(3):318–325

    Article  PubMed  Google Scholar 

  28. Wincent J, Holmberg E, Strömland K et al (2008) CHD7 mutation spectrum in 28 Swedish patients diagnosed with CHARGE syndrome. Clin Genet 74(1):31–38

    Article  CAS  PubMed  Google Scholar 

  29. Woodage T, Basrai MA, Baxevanis AD et al (1997) Characterization of the CHD family of proteins. Proc Natl Acad Sci USA 94(21):11472–11477

    Article  CAS  PubMed  Google Scholar 

  30. Writzl K, Cale CM, Pierce CM et al (2007) Immunological abnormalities in CHARGE syndrome. Eur J Med Genet 50(5):338–345

    Article  PubMed  Google Scholar 

  31. Yagi H, Furutani Y, Hamada H et al (2003) Role of TBX1 in human del22q11.2 syndrome. Lancet 362(9393):1366–1373

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that there was no financial support that might pose a conflict of interest in connection with the submitted article.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hidetoshi Takada.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Inoue, H., Takada, H., Kusuda, T. et al. Successful cord blood transplantation for a CHARGE syndrome with CHD7 mutation showing DiGeorge sequence including hypoparathyroidism. Eur J Pediatr 169, 839–844 (2010). https://doi.org/10.1007/s00431-009-1126-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-009-1126-6

Keywords

Navigation