nach oben

Journal of Clinical Immunology

Erschienen in:

01.01.2024 | Original Article

CVID-Associated Intestinal Disorders in the USIDNET Registry: An Analysis of Disease Manifestations, Functional Status, Comorbidities, and Treatment

verfasst von: Lauren E. Franzblau, Ramsay L. Fuleihan, Charlotte Cunningham-Rundles, Christian A. Wysocki

Erschienen in: Journal of Clinical Immunology | Ausgabe 1/2024

Einloggen, um Zugang zu erhalten

Abstract

Common variable immunodeficiency (CVID) has been subdivided into five phenotypes, including one marked by non-infectious enteropathies that lead to significant morbidity and mortality. We examined a large national registry of patients with CVID to better characterize this population and understand how the presence of enteropathy influences nutritional status, patient function, and the risk of additional non-infectious disorders in CVID patients. We also sought to illustrate the range of treatment strategies for CVID-associated enteropathies. We extracted patient data from the United States Immunodeficiency Network (USIDNET) database, which included 1415 patients with CVID, and compared those with and without intestinal disorders. Demographic and genetic profiles, functional status, and treatments targeting intestinal disorders are reported. Intestinal disorders were present in 20% of patients with CVID, including chronic diarrhea, inflammatory bowel disease, malabsorption, and others. Compared to those without enteropathies, this patient subset exhibited significantly lower Karnofsky-Lansky functional scores, greater reliance on nutritional support, higher rates of vitamin deficiencies, and increased prevalence of hematologic disorders, liver disease, pulmonary disease, granulomatous disease, and lymphoma. Genetic data were reported for only 5% of the cohort. No mutations segregated significantly to patients with or without intestinal disease. Corticosteroids were most frequently used for treatment. Patients with CVID-associated intestinal disorders exhibit higher rates of autoimmune and inflammatory comorbidities, lymphoma, malnutrition, and debility. We review recent studies implicating specific pathways underlying this immune dysregulation. Further studies are needed to evaluate the role of targeted immunomodulatory therapies for CVID-associated intestinal disorders.

Nur mit Berechtigung zugänglich

Chapel H, Lucas M, Lee M, Bjorkander J, Webster D, Grimbacher B, Fieschi C, Thon V, Abedi MR, Hammarstrom L. Common variable immunodeficiency disorders: division into distinct clinical phenotypes. Blood. 2008;112:277–86. https://doi.org/10.1182/blood-2007-11-124545.CrossRefPubMed

Ho HE, Cunningham-Rundles C. Non-infectious complications of common variable immunodeficiency: updated clinical spectrum, sequelae, and insights to pathogenesis. Front Immunol. 2020;11:149. https://doi.org/10.3389/fimmu.2020.00149.CrossRefPubMedPubMedCentral

Uzzan M, Ko HM, Mehandru S, Cunningham-Rundles C. Gastrointestinal disorders associated with common variable immune deficiency (CVID) and chronic granulomatous disease (CGD). Curr Gastroenterol Rep. 2016;18:17. https://doi.org/10.1007/s11894-016-0491-3.CrossRefPubMedPubMedCentral

Resnick ES, Moshier EL, Godbold JH, Cunningham-Rundles C. Morbidity and mortality in common variable immune deficiency over 4 decades. Blood. 2012;119:1650–7. https://doi.org/10.1182/blood-2011-09-377945.CrossRefPubMedPubMedCentral

Pensieri MV, Pulvirenti F, Schiepatti A, Maimaris S, Lattanzio S, Quinti I, Klersy C, Corazza GR, Biagi F. The high mortality of patients with common variable immunodeficiency and small bowel villous atrophy. Scand J Gastroenterol. 2019;54:164–8. https://doi.org/10.1080/00365521.2019.1568543.CrossRefPubMed

Pikkarainen S, Martelius T, Ristimäki A, Siitonen S, Seppänen MRJ, Färkkilä M. A high prevalence of gastrointestinal manifestations in common variable immunodeficiency. Am J Gastroenterol. 2019;114:648–655. https://doi.org/10.14309/ajg.0000000000000140.

Jørgensen SF, Reims HM, Frydenlund D, Holm K, Paulsen V, Michelsen AE, Jørgensen KK, Osnes LT, Bratlie J, Eide TJ, Dahl CP, Holter E, Tronstad RR, Hanevik K, Brattbakk HR, Kaveh F, Fiskerstrand T, Kran AMB, Ueland T, Karlsen TH, Aukrust P, Lundin KEA, Fevang B. A cross-sectional study of the prevalence of gastrointestinal symptoms and pathology in patients with common variable immunodeficiency. Am J Gastroenterol. 2016;111:1467–75. https://doi.org/10.1038/ajg.2016.329.CrossRefPubMed

Daniels JA, Lederman HM, Maitra A, Montgomery EA. Gastrointestinal tract pathology in patients with common variable immunodeficiency (CVID): a clinicopathologic study and review. Am J Surg Pathol. 2007;31:1800–12. https://doi.org/10.1097/PAS.0b013e3180cab60c.CrossRefPubMed

Malamut G, Verkarre V, Suarez F, Viallard JF, Lascaux AS, Cosnes J, Bouhnik Y, Lambotte O, Béchade D, Ziol M, Lavergne A, Hermine O, Cerf-Bensussan N, Cellier C. The enteropathy associated with common variable immunodeficiency: the delineated frontiers with celiac disease. Am J Gastroenterol. 2010;105:2262–75. https://doi.org/10.1038/ajg.2010.214.CrossRefPubMed

10.

Luzi G, Zullo A, Iebba F, Rinaldi V, Sanchez Mete L, Muscaritoli M, Aiuti F. Duodenal pathology and clinical-immunological implications in common variable immunodeficiency patients. Am J Gastroenterol. 2003;98:118–21. https://doi.org/10.1111/j.1572-0241.2003.07159.x.CrossRefPubMed

11.

Teahon K, Webster AD, Price AB, Weston J, Bjarnason I. Studies on the enteropathy associated with primary hypogammaglobulinaemia. Gut. 1994;35:1244–9. https://doi.org/10.1136/gut.35.9.1244.CrossRefPubMedPubMedCentral

12.

Biagi F, Bianchi PI, Zilli A, Marchese A, Luinetti O, Lougaris V, Plebani A, Villanacci V, Corazza GR. The significance of duodenal mucosal atrophy in patients with common variable immunodeficiency: a clinical and histopathologic study. Am J Clin Pathol. 2012;138:185–9. https://doi.org/10.1309/AJCPEIILH2C0WFYE.CrossRefPubMed

13.

Dhalla F, da Silva SP, Lucas M, Travis S, Chapel H. Review of gastric cancer risk factors in patients with common variable immunodeficiency disorders, resulting in a proposal for a surveillance programme. Clin Exp Immunol. 2011;165:1–7. https://doi.org/10.1111/j.1365-2249.2011.04384.x.CrossRefPubMedPubMedCentral

14.

Agarwal S, Cunningham-Rundles C. Autoimmunity in common variable immunodeficiency. Curr Allergy Asthma Rep. 2009;9:347–52. https://doi.org/10.1007/s11882-009-0051-0.CrossRefPubMedPubMedCentral

15.

Moriuchi H, Takayanagi T, Yamasaki S, Yasui M, Mori K, Yanai M, Yanagi T, Tsuji Y. Pernicious anemia in a patient with hypogammaglobulinemia. Acta Paediatr Jpn Overseas Ed. 1990;32:311–4. https://doi.org/10.1111/j.1442-200x.1990.tb00830.x.CrossRef

16.

Mannon PJ, Fuss IJ, Dill S, Friend J, Groden C, Hornung R, Yang Z, Yi C, Quezado M, Brown M, Strober W. Excess IL-12 but not IL-23 accompanies the inflammatory bowel disease associated with common variable immunodeficiency. Gastroenterology. 2006;131:748–56. https://doi.org/10.1053/j.gastro.2006.06.022.CrossRefPubMed

17.

Shulzhenko N, Dong X, Vyshenska D, Greer RL, Gurung M, Vasquez-Perez S, Peremyslova E, Sosnovtsev S, Quezado M, Yao M, Montgomery-Recht K, Strober W, Fuss IJ, Morgun A. CVID enteropathy is characterized by exceeding low mucosal IgA levels and interferon-driven inflammation possibly related to the presence of a pathobiont. Clin Immunol. 2018;197:139–53. https://doi.org/10.1016/j.clim.2018.09.008.CrossRefPubMedPubMedCentral

18.

Schubert D, Bode C, Kenefeck R, Hou TZ, James B, Kennedy A, Bulashevska A, Petersen B, Schäffer AA, Grüning BA, Unger S, Frede N, Baumann U, Witte T, Schmidt RE, Dueckers G, Niehues T, Seneviratne S, Speckmann C, Ehl S, Rensing-ehl A, Warnatz K. Europe PMC Funders Group Autosomal-dominant immune dysregulation syndrome in humans with CTLA4 mutations. 2015;20:1410–1416. https://doi.org/10.1038/nm.3746.Autosomal-dominant.

19.

Gámez-Díaz L, August D, Stepensky P, Revel-Vilk S, Seidel MG, Noriko M, Morio T, Worth AJJ, Blessing J, Van De Veerdonk F, Feuchtinger T, Kanariou M, Schmitt-Graeff A, Jung S, Seneviratne S, Burns S, Belohradsky BH, Rezaei N, Bakhtiar S, Speckmann C, Jordan M, Grimbacher B. The extended phenotype of LPS-responsive beige-like anchor protein (LRBA) deficiency. J Allergy Clin Immunol. 2016;137:223–30. https://doi.org/10.1016/j.jaci.2015.09.025.CrossRefPubMed

20.

Alangari A, Alsultan A, Adly N, Massaad MJ, Kiani IS, Aljebreen A, Raddaoui E, Almomen AK, Al-Muhsen S, Geha RS, Alkuraya FS. LPS-responsive beige-like anchor (LRBA) gene mutation in a family with inflammatory bowel disease and combined immunodeficiency. J Allergy Clin Immunol. 2012;130:481-8.e2. https://doi.org/10.1016/j.jaci.2012.05.043.CrossRefPubMedPubMedCentral

21.

Lopez-Herrera G, Tampella G, Pan-Hammarström Q, Herholz P, Trujillo-Vargas CM, Phadwal K, Simon AK, Moutschen M, Etzioni A, Mory A, Srugo I, Melamed D, Hultenby K, Liu C, Baronio M, Vitali M, Philippet P, Dideberg V, Aghamohammadi A, Rezaei N, Enright V, Du L, Salzer U, Eibel H, Pfeifer D, Veelken H, Stauss H, Lougaris V, Plebani A, Gertz EM, Schäffer AA, Hammarström L, Grimbacher B. Deleterious mutations in LRBA are associated with a syndrome of immune deficiency and autoimmunity. Am J Hum Genet. 2012;90:986–1001. https://doi.org/10.1016/j.ajhg.2012.04.015.CrossRefPubMedPubMedCentral

22.

Habibi S, Zaki-Dizaji M, Rafiemanesh H, Lo B, Jamee M, Gámez-Díaz L, Salami F, Kamali AN, Mohammadi H, Abolhassani H, Yazdani R, Aghamohammadi A, Anaya JM, Azizi G. Clinical, immunologic, and molecular spectrum of patients with LPS-responsive beige-like anchor protein deficiency: a systematic review. J Allergy Clin Immunol Pract. 2019;7:2379-2386.e5. https://doi.org/10.1016/j.jaip.2019.04.011.CrossRefPubMed

23.

Schwab C, Gabrysch A, Olbrich P, Patiño V, Warnatz K, Wolff D, Hoshino A, Kobayashi M, Imai K, Takagi M, Dybedal I, Haddock JA, Sansom DM, Lucena JM, Seidl M, Schmitt-Graeff A, Reiser V, Emmerich F, Frede N, Bulashevska A, Salzer U, Schubert D, Hayakawa S, Okada S, Kanariou M, Kucuk ZY, Chapdelaine H, Petruzelkova L, Sumnik Z, Sediva A, Slatter M, Arkwright PD, Cant A, Lorenz HM, Giese T, Lougaris V, Plebani A, Price C, Sullivan KE, Moutschen M, Litzman J, Freiberger T, van de Veerdonk FL, Recher M, Albert MH, Hauck F, Seneviratne S, PachlopnikSchmid J, Kolios A, Unglik G, Klemann C, Speckmann C, Ehl S, Leichtner A, Blumberg R, Franke A, Snapper S, Zeissig S, Cunningham-Rundles C, Giulino-Roth L, Elemento O, Dückers G, Niehues T, Fronkova E, Kanderová V, Platt CD, Chou J, Chatila TA, Geha R, McDermott E, Bunn S, Kurzai M, Schulz A, Alsina L, Casals F, Deyà-Martinez A, Hambleton S, Kanegane H, Taskén K, Neth O, Grimbacher B. Phenotype, penetrance, and treatment of 133 cytotoxic T-lymphocyte antigen 4–insufficient subjects. J Allergy Clin Immunol. 2018;142:1932–46. https://doi.org/10.1016/j.jaci.2018.02.055.CrossRefPubMedPubMedCentral

24.

Schubert D, Bode C, Kenefeck R, Hou TZ, Wing JB, Kennedy A, Bulashevska A, Petersen BS, Schäffer AA, Grüning BA, Unger S, Frede N, Baumann U, Witte T, Schmidt RE, Dueckers G, Niehues T, Seneviratne S, Kanariou M, Speckmann C, Ehl S, Rensing-Ehl A, Warnatz K, Rakhmanov M, Thimme R, Hasselblatt P, Emmerich F, Cathomen T, Backofen R, Fisch P, Seidl M, May A, Schmitt-Graeff A, Ikemizu S, Salzer U, Franke A, Sakaguchi S, Walker LSK, Sansom DM, Grimbacher B. Autosomal dominant immune dysregulation syndrome in humans with CTLA4 mutations. Nat Med. 2014;20:1410–6. https://doi.org/10.1038/nm.3746.CrossRefPubMedPubMedCentral

25.

Kuehn HS, Ouyang W, Lo B, Deenick EK, Niemela JE, Avery DT, Schickel JN, Tran DQ, Stoddard J, Zhang Y, Frucht DM, Dumitriu B, Scheinberg P, Folio LR, Frein CA, Price S, Koh C, Heller T, Seroogy CM, Huttenlocher A, Rao VK, Su HC, Kleiner D, Notarangelo LD, Rampertaap Y, Olivier KN, McElwee J, Hughes J, Pittaluga S, Oliveira JB, Meffre E, Fleisher TA, Holland SM, Lenardo MJ, Tangye SG, Uzel G. Immune dysregulation in human subjects with heterozygous germline mutations in CTLA4. Science. 2014;345(80):1623–7. https://doi.org/10.1126/science.1255904.CrossRefPubMedPubMedCentral

26.

Washington K, Stenzel TT, Buckley RH, Gottfried MR. Gastrointestinal pathology in patients with common variable immunodeficiency and X-linked agammaglobulinemia. Am J Surg Pathol. 1996;20:1240–52. https://doi.org/10.1097/00000478-199610000-00010.CrossRefPubMed

27.

Fischer A, Provot J, Jais JP, Alcais A, Mahlaoui N, Adoue D, Aladjidi N, Amoura Z, Arlet P, Armari-Alla C, Bader-Meunier B, Barlogis V, Bayart S, Beaurain B, Bertrand Y, Bienvenu B, Blanche S, Bodet D, Bonnotte B, Borie R, Boutard P, Briandet C, Brion JP, Brito C, Brouard J, Catherinot E, Chandesris O, Cohen-Beaussant S, Coignard-Biehler H, Costes L, Couderc LJ, Couillault G, Courteille V, Curlier E, de Saint Basile G, Demeocq F, de Vergnes N, Devoldere C, Deville A, Donadieu J, Dore E, Dulieu F, Durieu I, Edan C, Entz Werle N, Fieschi C, Fouyssac F, Frange P, Gajdos V, Galicier L, Gandemer V, Gardembas M, Gaud C, Grosbois B, Guillerm G, Hachulla E, Hamidou M, Héritier S, Hermine O, Hoarau C, Hoen B, Hot A, Humbert S, Jaccard A, Jacquot S, Jais JP, Jaussaud R, Jeandel PY, Jeziorski E, Kebaili K, Korganow AS, Labrune P, Lambotte O, Lanternier F, Larroche C, Le Quellec A, Le Moigne E, Le Moing V, Lebranchu Y, Lecuit M, Lefevre G, Lemal R, Le Moine P, Li Thiao Te V, Lortholary O, Lutz P, Magerus-Chatinet A, Malphettes M, Marie-Cardine A, Martin Silva N, Masseau A, Massot C, Mazingue F, Merlin E, Michel G, Millot F, Minckes O, Monlibert B, Monpoux F, Moshous D, Mouthon L, Munzer M, Neven B, Nove-Josserand R, Oksenhendler E, Ouachée-Chardin M, Pagnier A, Pasquali JL, Pasquet M, Pellier I, Perel Y, Perlat A, Picard C, Piguet C, Plantaz D, Quartier P, Rieux-Laucat F, Roblot P, Roger PM, Rohrlich PS, Royer B, Salle V, Sarrot-Reynauld F, Servettaz A, Stephan JL, Schleinitz N, Suarez F, Swiader L, Taque S, Thomas C, Tournilhac O, Thumerelle C, Vannier JP, Viallard JF. Autoimmune and inflammatory manifestations occur frequently in patients with primary immunodeficiencies. J Allergy Clin Immunol. 2017;140:1388–1393e8. https://doi.org/10.1016/j.jaci.2016.12.978.

28.

Gathmann B, Mahlaoui N, Gérard L, Oksenhendler E, Warnatz K, Schulze I, Kindle G, Kuijpers TW, Van Beem RT, Guzman D, Workman S, Soler-Palacín P, De Gracia J, Witte T, Schmidt RE, Litzman J, Hlavackova E, Thon V, Borte M, Borte S, Kumararatne D, Feighery C, Longhurst H, Helbert M, Szaflarska A, Sediva A, Belohradsky BH, Jones A, Baumann U, Meyts I, Kutukculer N, Wågström P, Galal NM, Roesler J, Farmaki E, Zinovieva N, Ciznar P, Papadopoulou-Alataki E, Bienemann K, Velbri S, Panahloo Z, Grimbacher B. Clinical picture and treatment of 2212 patients with common variable immunodeficiency. J Allergy Clin Immunol. 2014;134. https://doi.org/10.1016/j.jaci.2013.12.1077.

29.

Rakhmanov M, Keller B, Gutenberger S, Foerster C, Hoenig M, Driessen G, Van Der Burg M, Van Dongen JJ, Wiech E, Visentini M, Quinti I, Prasse A, Voelxen N, Salzer U, Goldacker S, Fisch P, Eibel H, Schwarz K, Peter HH, Warnatz K. Circulating CD21low B cells in common variable immunodeficiency resemble tissue homing, innate-like B cells. Proc Natl Acad Sci U S A. 2009;106:13451–6. https://doi.org/10.1073/pnas.0901984106.CrossRefPubMedPubMedCentral

30.

Gereige JD, Maglione PJ. Current understanding and recent developments in common variable immunodeficiency associated autoimmunity. Front Immunol. 2019;10:0–1. https://doi.org/10.3389/fimmu.2019.02753.

31.

Jørgensen SF, Trøseid M, Kummen M, Anmarkrud JA, Michelsen AE, Osnes LT, Holm K, Høivik ML, Rashidi A, Dahl CP, Vesterhus M, Halvorsen B, Mollnes TE, Berge RK, Moum B, Lundin KEA, Fevang B, Ueland T, Karlsen TH, Aukrust P, Hov JR. Altered gut microbiota profile in common variable immunodeficiency associates with levels of lipopolysaccharide and markers of systemic immune activation. Mucosal Immunol. 2016;9:1455–65. https://doi.org/10.1038/mi.2016.18.CrossRefPubMed

32.

Berbers RM, van der Wal MM, van Montfrans JM, Ellerbroek PM, Dalm VASH, van Hagen PM, Leavis HL, van Wijk F. Chronically activated T-cells retain their inflammatory properties in common variable immunodeficiency. J Clin Immunol. 2021. https://doi.org/10.1007/s10875-021-01084-6.CrossRefPubMedPubMedCentral

33.

Cunningham-Rundles C. How I treat common variable immune deficiency. Blood. 2010;116:7–15. https://doi.org/10.1182/blood-2010-01-254417.CrossRefPubMedPubMedCentral

34.

Abolhassani H, Sagvand BT, Shokuhfar T, Mirminachi B, Rezaei N, Aghamohammadi A. A review on guidelines for management and treatment of common variable immunodeficiency. Expert Rev Clin Immunol. 2013;9:561–75. https://doi.org/10.1586/eci.13.30.CrossRefPubMed

35.

Verma N, Burns SO, Walker LSK, Sansom DM. Immune deficiency and autoimmunity in patients with CTLA-4 (CD152) mutations. Clin Exp Immunol. 2017;190:1–7. https://doi.org/10.1111/cei.12997.CrossRefPubMedPubMedCentral

36.

Lee S, Moon JS, Lee CR, Kim HE, Baek SM, Hwang S, Kang GH, Seo JK, Shin CH, Kang HJ, Ko JS, Park SG, Choi M. Abatacept alleviates severe autoimmune symptoms in a patient carrying a de novo variant in CTLA-4. J Allergy Clin Immunol. 2016;137:327–30. https://doi.org/10.1016/j.jaci.2015.08.036.CrossRefPubMed

37.

Milner JD, Vogel TP, Forbes L, Ma CA, Stray-Pedersen A, Niemela JE, Lyons JJ, Engelhardt KR, Zhang Y, Topcagic N, Roberson EDO, Matthews H, Verbsky JW, Dasu T, Vargas-Hernandez A, Varghese N, McClain KL, Karam LB, Nahmod K, Makedonas G, Mace EM, Sorte HS, Perminow G, Koneti Rao V, O’Connell MP, Price S, Su HC, Butrick M, McElwee J, Hughes JD, Willet J, Swan D, Xu Y, Santibanez-Koref M, Slowik V, Dinwiddie DL, Ciaccio CE, Saunders CJ, Septer S, Kingsmore SF, White AJ, Cant AJ, Hambleton S, Cooper MA. Early-onset lymphoproliferation and autoimmunity caused by germline STAT3 gain-of-function mutations. Blood. 2015;125:591–9. https://doi.org/10.1182/blood-2014-09-602763.CrossRefPubMedPubMedCentral

38.

Forbes LR, Vogel TP, Cooper MA, Castro-Wagner J, Schussler E, Weinacht KG, Plant AS, Su HC, Allenspach EJ, Slatter M, Abinun M, Lilic D, Cunningham-Rundles C, Eckstein O, Olbrich P, Guillerman RP, Patel NC, Demirdag YY, Zerbe C, Freeman AF, Holland SM, Szabolcs P, Gennery A, Torgerson TR, Milner JD, Leiding JW. Jakinibs for the treatment of immune dysregulation in patients with gain-of-function signal transducer and activator of transcription 1 (STAT1) or STAT3 mutations. J Allergy Clin Immunol. 2018;142:1665–9. https://doi.org/10.1016/j.jaci.2018.07.020.CrossRefPubMedPubMedCentral

Titel: CVID-Associated Intestinal Disorders in the USIDNET Registry: An Analysis of Disease Manifestations, Functional Status, Comorbidities, and Treatment
verfasst von: Lauren E. Franzblau
Ramsay L. Fuleihan
Charlotte Cunningham-Rundles
Christian A. Wysocki
Publikationsdatum: 01.01.2024
Verlag: Springer US
Erschienen in: Journal of Clinical Immunology / Ausgabe 1/2024
Print ISSN: 0271-9142
Elektronische ISSN: 1573-2592
DOI: https://doi.org/10.1007/s10875-023-01604-6

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

CVID-Associated Intestinal Disorders in the USIDNET Registry: An Analysis of Disease Manifestations, Functional Status, Comorbidities, and Treatment

Abstract

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Erhebliches Risiko für Kehlkopfkrebs bei mäßiger Dysplasie

Nach Herzinfarkt mit Typ-1-Diabetes schlechtere Karten als mit Typ 2?

15% bedauern gewählte Blasenkrebs-Therapie

Costims – das nächste heiße Ding in der Krebstherapie?

Update Innere Medizin

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2024

Recent Insights in Pyrin Inflammasome Activation: Identifying Potential Novel Therapeutic Approaches in Pyrin-Associated Autoinflammatory Syndromes

Proposal for a Disease Activity Score and Disease Damage Score for ADA2 Deficiency: the DADA2AI and DADA2DI

Fatal COVID-19 Infection in Two Children with STAT1 Gain-of-Function

Ruxolitinib Rescues Multiorgan Clinical Autoimmunity in Patients with APS-1

Four-Year-History of Recurrent Fever, Skin Lesions, and Liver Abscesses in a Patient with Common Variable Immune Deficiency due to Helicobacter cinaedi Infection

Clinical Course and Family History of Adult Patient with Novel MYSM1 Variant

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Erhebliches Risiko für Kehlkopfkrebs bei mäßiger Dysplasie

Nach Herzinfarkt mit Typ-1-Diabetes schlechtere Karten als mit Typ 2?

15% bedauern gewählte Blasenkrebs-Therapie

Costims – das nächste heiße Ding in der Krebstherapie?

Update Innere Medizin