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      Human genetics of meningococcal infections

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          Abstract

          Neisseria meningitidis is a leading cause of bacterial septicaemia and meningitis worldwide. Meningococcal disease is rare but can be life threatening with a tendency to affect children. Many studies have investigated the role of human genetics in predisposition to N. meningitidis infection. These have identified both rare single-gene mutations as well as more common polymorphisms associated with meningococcal disease susceptibility and severity. These findings provide clues to the pathogenesis of N. meningitidis, the basis of host susceptibility to infection and to the aetiology of severe disease. From the multiple discoveries of monogenic complement deficiencies to the associations of complement factor H and complement factor H-related three polymorphisms to meningococcal disease, the complement pathway is highlighted as being central to the genetic control of meningococcal disease. This review aims to summarise the current understanding of the host genetic basis of meningococcal disease with respect to the different stages of meningococcal infection.

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          Most cited references172

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          Meningococcal disease.

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            Pyogenic bacterial infections in humans with MyD88 deficiency.

            MyD88 is a key downstream adapter for most Toll-like receptors (TLRs) and interleukin-1 receptors (IL-1Rs). MyD88 deficiency in mice leads to susceptibility to a broad range of pathogens in experimental settings of infection. We describe a distinct situation in a natural setting of human infection. Nine children with autosomal recessive MyD88 deficiency suffered from life-threatening, often recurrent pyogenic bacterial infections, including invasive pneumococcal disease. However, these patients were otherwise healthy, with normal resistance to other microbes. Their clinical status improved with age, but not due to any cellular leakiness in MyD88 deficiency. The MyD88-dependent TLRs and IL-1Rs are therefore essential for protective immunity to a small number of pyogenic bacteria, but redundant for host defense to most natural infections.
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              GATA2 deficiency: a protean disorder of hematopoiesis, lymphatics, and immunity.

              Haploinsufficiency of the hematopoietic transcription factor GATA2 underlies monocytopenia and mycobacterial infections; dendritic cell, monocyte, B, and natural killer (NK) lymphoid deficiency; familial myelodysplastic syndromes (MDS)/acute myeloid leukemia (AML); and Emberger syndrome (primary lymphedema with MDS). A comprehensive examination of the clinical features of GATA2 deficiency is currently lacking. We reviewed the medical records of 57 patients with GATA2 deficiency evaluated at the National Institutes of Health from January 1, 1992, to March 1, 2013, and categorized mutations as missense, null, or regulatory to identify genotype-phenotype associations. We identified a broad spectrum of disease: hematologic (MDS 84%, AML 14%, chronic myelomonocytic leukemia 8%), infectious (severe viral 70%, disseminated mycobacterial 53%, and invasive fungal infections 16%), pulmonary (diffusion 79% and ventilatory defects 63%, pulmonary alveolar proteinosis 18%, pulmonary arterial hypertension 9%), dermatologic (warts 53%, panniculitis 30%), neoplastic (human papillomavirus+ tumors 35%, Epstein-Barr virus+ tumors 4%), vascular/lymphatic (venous thrombosis 25%, lymphedema 11%), sensorineural hearing loss 76%, miscarriage 33%, and hypothyroidism 14%. Viral infections and lymphedema were more common in individuals with null mutations (P = .038 and P = .006, respectively). Monocytopenia, B, NK, and CD4 lymphocytopenia correlated with the presence of disease (P < .001). GATA2 deficiency unites susceptibility to MDS/AML, immunodeficiency, pulmonary disease, and vascular/lymphatic dysfunction. Early genetic diagnosis is critical to direct clinical management, preventive care, and family screening.
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                Author and article information

                Contributors
                v.sancho-shimizu@imperial.ac.uk
                Journal
                Hum Genet
                Hum. Genet
                Human Genetics
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0340-6717
                1432-1203
                17 February 2020
                17 February 2020
                2020
                : 139
                : 6
                : 961-980
                Affiliations
                [1 ]GRID grid.7445.2, ISNI 0000 0001 2113 8111, Department of Paediatric Infectious Disease, Faculty of Medicine, , Imperial College London, ; Norfolk Place, London, W2 1PG UK
                [2 ]GRID grid.7445.2, ISNI 0000 0001 2113 8111, Department of Virology, Faculty of Medicine, , Imperial College London, ; Norfolk Place, London, W2 1PG UK
                Author information
                http://orcid.org/0000-0002-3519-0727
                Article
                2128
                10.1007/s00439-020-02128-4
                7272491
                32067109
                5085829a-2fbb-41ab-b6ec-9bf21631b3d6
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 16 November 2019
                : 2 February 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100011199, FP7 Ideas: European Research Council;
                Award ID: 279185
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100000272, National Institute for Health Research;
                Award ID: P76547
                Award Recipient :
                Funded by: UK Research and Innovation Future Leaders Fellowship
                Award ID: MR/S032304/1
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100012295, NIHR Newcastle Biomedical Research Centre;
                Award ID: PhD studentship
                Award Recipient :
                Categories
                Review
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2020

                Genetics
                Genetics

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