title: Role of Flow Cytometry in the Diagnosis of Chronic Granulomatous Disease: the Egyptian Experience.
abstract: Chronic granulomatous disease (CGD) is an inherited mutational defect in any of the NADPH oxidase complex, CYBB (gp91-phox), NCF1 (p47-phox), CYBA (p22-phox), NCF2 (p67-phox), or NCF4 (p40-phox) leading to inability of phagocytes to perform effective respiratory burst and thus diminished killing of bacteria and fungi. The identification of defective proteins aids in establishing a diagnosis prior to genetic analysis, which is rather labor-intensive, expensive, and time-consuming.
  
  
  
  The present study aims at assessing the NADPH proteins by performing the intracellular staining with specific monoclonal antibodies and their assessment on flow cytometry. The use of flow cytometry is less laborious and faster to perform than western blot. It also confirms the diagnosis of CGD and detects the affected components allowing proper management of patients.
  
  
  
  Twenty-eight patients from 25 different kindred, clinically suspected as CGD were recruited in Egypt. Dihydrorhodamine test was performed to confirm the diagnosis of the patients. Intracellular staining of NADPH components using specific monoclonal antibodies was performed followed by flow cytometric analysis.
  
  
  
  The present study revealed that the most common defective protein in our cohort is p22-phox, found in 13 patients (46.4 % of cases) followed by p47-phox in 8 patients (28.6 %), gp91-phox in 5 patients (17.9 %), and finally p67-phox in 2 patients (7.1 %).
  
  
  
  In countries with limited resources and yet large number of CGD patients, the analysis of the defective proteins by flow cytometry is an optimum solution for confirming the diagnosis and is a step for targeted sequencing in families seeking prenatal diagnosis.
authors.affiliation: Clinical Pathology Department, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt. rabab_elhawary@hotmail.com.
authors.forename: Rabab
authors.initials: R
authors.lastname: El Hawary
authors.affiliation: Clinical Pathology Department, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt.
authors.forename: Safa
authors.initials: S
authors.lastname: Meshaal
authors.affiliation: Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale, INSERM UMR1163, Paris, France.|Imagine Institute, Paris Descartes University, Paris, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Deswarte
authors.affiliation: Pediatrics Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Nermeen
authors.initials: N
authors.lastname: Galal
authors.affiliation: Clinical Pathology Department, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt.
authors.forename: Mahitab
authors.initials: M
authors.lastname: Abdelkawy
authors.affiliation: Pediatrics Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Radwa
authors.initials: R
authors.lastname: Alkady
authors.affiliation: Pediatrics Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Dalia Abd
authors.initials: DA
authors.lastname: Elaziz
authors.affiliation: Molecular Genetics Laboratory, Centre for Cardiovascular Surgery and Transplantation, Brno, Czech Republic.|Department of Clinical Immunology and Allergology, Medical Faculty, Masaryk University, Brno, Czech Republic.
authors.forename: Tomas
authors.initials: T
authors.lastname: Freiberger
authors.affiliation: Molecular Genetics Laboratory, Centre for Cardiovascular Surgery and Transplantation, Brno, Czech Republic.
authors.forename: Barbora
authors.initials: B
authors.lastname: Ravcukova
authors.affiliation: Department of Clinical Immunology and Allergology, Medical Faculty, Masaryk University, Brno, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Litzman
authors.affiliation: Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale, INSERM UMR1163, Paris, France.|Imagine Institute, Paris Descartes University, Paris, France.|Center for the Study of Primary Immunodeficiencies, Assistance Publique-Hôpitaux de Paris AP-HP, Necker Hospital for Sick Children, Paris, France.|St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA.
authors.forename: Jacinta
authors.initials: J
authors.lastname: Bustamante
authors.affiliation: Pediatrics Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Jeannette
authors.initials: J
authors.lastname: Boutros
authors.affiliation: Clinical Pathology Department, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt.
authors.forename: Taghrid
authors.initials: T
authors.lastname: Gaafar
authors.affiliation: Pediatrics Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Aisha
authors.initials: A
authors.lastname: Elmarsafy
mesh_terms: D015415:Biomarkers; D002648:Child; D002675:Child, Preschool; D004534:Egypt; D005260:Female; D005434:Flow Cytometry; D005838:Genotype; D006105:Granulomatous Disease, Chronic / Q000175:diagnosis* / Q000235:genetics / Q000276:immunology / Q000378:metabolism; D006801:Humans; D016130:Immunophenotyping; D007223:Infant; D008297:Male; D009154:Mutation; D009249:NADP / Q000378:metabolism; D019255:NADPH Oxidases / Q000378:metabolism; D009504:Neutrophils / Q000276:immunology / Q000378:metabolism; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D009249:NADP; D019255:NADPH Oxidases
keywords: CYBA; CYBB; Chronic granulomatous disease; Flow cytometry; NCF1; NCF2