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Blood, 15 May 2004, Vol. 103, No. 10, pp. 3915-3923.
Prepublished online as a Blood First Edition Paper on February 5, 2004; DOI 10.1182/blood-2003-11-3940.
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PHAGOCYTES
Neutrophils in Barth syndrome (BTHS) avidly bind annexin-V in the absence of apoptosis
Taco W. Kuijpers,
Nikolai A. Maianski,
Anton T. J. Tool,
Kolja Becker,
Barbara Plecko,
Fredoen Valianpour,
Ron J. A. Wanders,
Rob Pereira,
Johan Van Hove,
Arthur J. Verhoeven,
Dirk Roos,
Frank Baas, and
Peter G. Barth
From the Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, the Netherlands; Sanquin Research at CLB, and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, the Netherlands; Department of Pediatric Cardiology, University Children's Hospital, Kiel, Germany; Department of Pediatrics, University Hospital Graz, Austria; Department of Pediatrics, Medical Centre Rijnmond-Zuid, Rotterdam, the Netherlands; and Department of Pediatrics, University Hospital Leuven, Belgium.
Barth syndrome (BTHS) is a rare X-linked disease characterized by a triad of dilated cardiomyopathy, skeletal myopathy, and neutropenia. The disease is associated with mutations of the TAZ gene, resulting in defective cardiolipin (CL), an important inner mitochondrial membrane component. Untreated boys die in infancy or early childhood from septicemia or cardiac failure. To date, neutrophil function has never been studied. Directed motility and killing activity of neutrophils was investigated in 7 BTHS patients and found normal in those tested. The circulating neutrophils and eosinophils (but not monocytes or lymphocytes) showed annexin-V binding, suggesting phosphatidylserine (PS) exposure due to apoptosis. However, caspase activity was absent in fresh BTHS cells. Unexpectedly, the near absence of CL impacted neither the mitochondrial mass and shape in fresh BTHS neutrophils nor mitochondrial clustering and Bax translocation upon apoptosis. Annexin-V binding to BTHS neutrophils was not caused by phospholipid scrambling. Moreover, freshly purified BTHS neutrophils were not phagocytosed by macrophages. In sum, a massive number of circulating annexin-V–binding neutrophils in the absence of apoptosis can be demonstrated in BTHS. These neutrophils expose an alternative substrate for annexin-V different from PS and not recognized by macrophages, excluding early clearance as an explanation for the neutropenia.
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