NIH-supported study suggests that early diagnosis of severe    combined immunodeficiency leads to high survival rates  
    A newborn screening test for severe combined immunodeficiency    (SCID) reliably identifies infants with this life-threatening    inherited condition, leading to prompt treatment and high    survival rates, according to a study supported by the National    Institutes of Health. Researchers led by Jennifer Puck, M.D.,    of the University of California, San Francisco, also found that    SCID affects approximately 1 in 58,000 newborns, indicating    that the disorder is less rare than previously thought. The    study was funded in part by NIHs National Institute of Allergy    and Infectious Diseases (NIAID) and Eunice Kennedy    Shriver National Institute of Child Health and Human    Development (NICHD). It appears in the Aug. 20 issue of the    Journal of the American Medical Association.  
      Blood is collected from a newborn for screening. Credit: U.S.      Air Force photo/Staff Sgt Eric T. Sheler    
    SCID is a group of disorders caused by defects in genes    involved in the development and function of T cells and other    infection-fighting immune cells. Infants with SCID are highly    susceptible to life-threatening infections. SCID is fatal,    usually within the first year or two of life, unless affected    infants are given immune-restoring treatments such as    transplants of blood-forming stem cells or gene therapy. More    than 80 percent of affected infants do not have a family    history of the condition.  
    The results of this study highlight the important role of    newborn screening for SCID, said NIAID Director Anthony S.    Fauci, M.D.The findings demonstrate that detecting SCID    before symptoms such as severe infections appear helps ensure    that infants with this serious condition receive lifesaving    treatments.  
    The SCID newborn screening test, originally developed at    NIH, measures T cell receptor excision circles (TRECs), a    byproduct of T-cell development. Infants with SCID have few or    no T cells, regardless of the underlying genetic defect, and    the absence of TRECs may indicate SCID.The TREC test also    may help doctors identify infants with non-SCID T-cell    deficiencies. SCID was added in 2010 to the U.S. Department of    Health and Human Services Recommended Uniform Screening Panel     for newborns in the United    States. However, the TREC test has not yet been adopted    universally. Nearly half of states conduct newborn screening    for SCID, and the test is performed for almost two thirds of    infants born across the country.  
    We have made great strides in our knowledge of SCID and other    related immunodeficiencies in a relatively short period of    time, thanks to newborn screening, said Tiina Urv, Ph.D., a    program director in the Intellectual and Developmental    Disabilities Branch at NICHD. Such collaborative research    efforts could serve as a model for other disorders.  
    The current study evaluated data from more than 3 million    newborns gathered by screening programs in 10 states and the    Navajo Nation, which spans parts of Arizona, New Mexico and    Utah. Navajo have a higher than average risk of SCID, due to    certain genetic mutations. Overall, screening detected 52    newborns with SCID, equivalent to 1 in 58,000 infants. All    infants with abnormal TREC results underwent further diagnostic    testing to confirm SCID. The researchers did not identify any    cases of SCID that were missed by TREC screening. Previous    estimates, based on limited data, suggested that SCID was less    prevalent, affecting only 1 in 100,000 babies.  
    Early diagnosis allows physicians to treat SCID infants    promptly, before infections become overwhelming. Of the 52 SCID    infants in the current study, 49 received immune-restoring    therapies such as stem cell transplants, enzyme replacement    therapy or gene therapy. Three infants died before treatment    was given. Four died after receiving transplants, while the    other 45 treated infants (92 percent) survived. A recent        NIH-funded study showed that SCID infants who received stem    cell transplants early in life (less than 3.5 months old) and    before the onset of infections had the best outcomes.  
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