Background: Gaucher disease (GD) is a rare disorder characterized by defective function of β-glucocerebrosidase, which leads to progressive accumulation of its substrate in various organs, particularly the mononuclear phagocyte system. Hepatosplenomegaly and cytopenia represent the disease's most common features but GD patients also show hyperinflammation, hypergammaglobulinemia and immune-dysregulation involving B, T and NK-cells. As clinical phenotype can be underhand, symptoms can overlap with autoimmune lymphoproliferative syndrome (ALPS) or other ALPS-like disorders.
Objective: To evaluate the ALPS-like immunological pattern and apoptosis function in patients with GD.
Methods: We evaluated lymphocyte subsets and immunophenotypic and serological features of ALPS [double-negative T cells (DNTs), B220+DNTs, CD27+,T-reg/HLA-DR ratio, IL-10, IL-18, vitamin B12] in a population of GD patients. Moreover, we tested FAS/TRAIL-induced apoptosis and CASP8/CASP10/PARP function in patients showing an immune-dysregulation pattern.
Results: A total of 41 patients (33 treated, 8 treatment-naïve) were studied. Nine (21%) and 7 (17%) out of 41 patients had high DNTs and B220+DNTs counts, respectively. Overall, 10/41(24%) patients showed immunological features suggestive of ALPS that were more frequent in treatment-naïve subjects (p =0.040 vs. p=0.031) and in those with early onset of the disease (p=0.046 vs. p=0.011), respectively. FAS-induced apoptosis and caspase activation were further evaluated in these 10 patients and were found to be defective in seven of them.
Conclusion: We show that patients with GD may have ALPS-like features and FAS-mediated apoptosis defects that are more pronounced in treatment-naïve subjects and in patients with early onset of the disease. Therefore, diagnostic work-up of patients with an ALPS-like phenotype should include screening for GD.
Keywords: Gaucher disease; autoimmunelymphoproliferative syndrome; lymphocyte apoptosis defect.