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Deficiency of the Fas apoptosis pathway without Fas gene mutations in
pediatric patients with autoimmunity/lymphoproliferation
U Dianzani, M Bragardo, D DiFranco, C Alliaudi, P Scagni, D Buonfiglio, V Redoglia, S Bonissoni, A Correra, I Dianzani and U Ramenghi
Dipartimento di Scienze Mediche, Universita di Torino, Novara, Italy.
Fas (CD95) is a transmembrane molecule that induces programmed cell death
(PCD) of lymphocytes. We examined its function in children with chronic
thrombocytopenia, serum autoantibodies, and lymphadenopathy and/or
splenomegaly. We found that T-cell lines from six of seven patients with
this autoimmune/lymphoproliferative disease (ALD) were relatively resistant
to PCD induced by monoclonal antibodies to Fas. By contrast, Fas function
was normal in control patients with typical chronic idiopathic
thrombocytopenic purpura (ITP) without lymphadenopathy. The defect was not
due to decreased Fas expression, nor to over-production of soluble forms of
Fas. Moreover, it specifically involved the Fas system because PCD was
induced in the normal way by methylprednisolone. Complementary DNA
sequencing of the Fas gene did not identify any causal mutation in patients
with ALD. This distinguished them from patients with the human autoimmune
lymphoproliferative syndrome (ALPS), who carry mutations of the Fas gene.
Moreover, patients with ALD did not show the peripheral expansion of
CD4/CD8 double-negative T cells that characterizes the ALPS phenotype. Fas
signaling involves activation of a sphingomyelinase- catalyzing production
of ceramide. We found that ceramide-induced PCD was defective in patients
with ALD and not in patients with typical chronic ITP. These data suggest
that the ALD patient defect involves the Fas signaling pathway downstream
from the sphingomyelinase and that Fas gene mutations and double-negative
T-cell expansion are not the only signs of a defective Fas system.
Volume 89,
Issue 8,
pp. 2871-2879,
04/15/1997
Copyright © 1997 by The American Society of Hematology

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