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Clinical Trial
. 2007 Apr 15;109(8):3529-37.
doi: 10.1182/blood-2006-05-021402. Epub 2006 Dec 21.

Natural history and early diagnosis of LAD-1/variant syndrome

Taco W Kuijpers  1 , Robin van Bruggen, Nanne Kamerbeek, Anton T J Tool, Gonul Hicsonmez, Aytemiz Gurgey, Axel Karow, Arthur J Verhoeven, Karl Seeger, Ozden Sanal, Charlotte Niemeyer, Dirk Roos
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Free article
Clinical Trial

Natural history and early diagnosis of LAD-1/variant syndrome

Taco W Kuijpers et al. Blood. .
Free article

Abstract

The syndrome of leukocyte adhesion deficiency (LAD) combined with a severe Glanzmann-type bleeding disorder has been recognized as a separate disease entity. The variability in clinical and cell biological terms has remained largely unclear. We present data on 9 cases from 7 unrelated families, with 3 patients being actively followed for more than 12 years. The disease entity, designated LAD-1/variant syndrome, presents early in life and consists of nonpussing infections from bacterial and fungal origin, as well as a severe bleeding tendency. This is compatible with 2 major blood cell types contributing to the clinical symptoms (ie, granulocytes and platelets). In granulocytes of the patients, we found adhesion and chemotaxis defects, as well as a defect in NADPH oxidase activity triggered by unopsonized zymosan. This last test can be used as a screening test for the syndrome. Many proteins and genes involved in adhesion and signaling, including small GTPases such as Rap1 and Rap2 as well as the major Rap activity-regulating molecules, were normally present. Moreover, Rap1 activation was intact in patients' blood cells. Defining the primary defect awaits genetic linkage analysis, which may be greatly helped by a more precise understanding and awareness of the disease combined with the early identification of affected patients.

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Comment in

  • LAD III versus LAD I variant.
    Etzioni A, Alon R. Etzioni A, et al. Blood. 2007 Dec 1;110(12):4129; author reply 4129-30. doi: 10.1182/blood-2007-05-089227. Blood. 2007. PMID: 18024798 No abstract available.

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