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Impact of folate therapy on combined immunodeficiency secondary to hereditary folate malabsorption.

Abstract
Hereditary folate malabsorption (HFM) is a rare autosomal recessive disorder. Severe folate deficiency in HFM can result in immunodeficiency. We describe a female infant with HFM who acquired severe Pneumocystis pneumonia. The objective of the present study was to elucidate her immunological phenotype and to examine the time course of immune recovery following parenteral folate therapy. The patient demonstrated a combined immunodeficiency with an impaired T cell proliferation response, pan-hypogammaglobulinemia, and an imbalanced pro-inflammatory cytokine profile. She had normal white blood cell count, normal lymphocyte subsets, and normal complement levels. Two novel mutations were identified within the SLC46A1 gene to produce a compound heterozygote. We confirmed full recovery of her immunological and neurophysiological status with parenteral folate replacement. The time course of recovery of her immunological profile varied widely, however. HFM should be recognized as a unique form of immunodeficiency.
AuthorsKenji Kishimoto, Ryoji Kobayashi, Hirozumi Sano, Daisuke Suzuki, Hayato Maruoka, Kazue Yasuda, Natsuko Chida, Masafumi Yamada, Kunihiko Kobayashi
JournalClinical immunology (Orlando, Fla.) (Clin Immunol) Vol. 153 Issue 1 Pg. 17-22 (Jul 2014) ISSN: 1521-7035 [Electronic] United States
PMID24691418 (Publication Type: Case Reports, Journal Article)
CopyrightCopyright © 2014 Elsevier Inc. All rights reserved.
Chemical References
  • Cytokines
  • Immunoglobulin Isotypes
  • Proton-Coupled Folate Transporter
  • SLC46A1 protein, human
  • Folic Acid
Topics
  • Blood Cell Count
  • Cytokines (blood)
  • Female
  • Folic Acid (therapeutic use)
  • Folic Acid Deficiency (complications)
  • Heterozygote
  • Humans
  • Immunoglobulin Isotypes (blood, immunology)
  • Immunologic Deficiency Syndromes (diagnosis, drug therapy, etiology)
  • Infant
  • Lymphocyte Activation (immunology)
  • Lymphocyte Subsets (immunology, metabolism)
  • Malabsorption Syndromes (complications)
  • Mutation
  • Proton-Coupled Folate Transporter (genetics)

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