The many faces of Artemis-deficient combined immunodeficiency — Two patients with DCLRE1C mutations and a systematic literature review of genotype–phenotype correlation

• Published in: Clinical immunology (Orlando, Fla.) Vol. 149; no. 3; pp. 464 - 474
• Main Authors: Lee, Pamela P, Woodbine, Lisa, Gilmour, Kimberly C, Bibi, Shahnaz, Cale, Catherine M, Amrolia, Persis J, Veys, Paul A, Davies, E. Graham, Jeggo, Penny A, Jones, Alison
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2013
• Subjects: Adult; Allergy and Immunology; Amino Acid Sequence; Artemis; Child, Preschool; Combined immunodeficiency; DCLRE1C; Endonucleases; Female; Genetic Association Studies; Genetic Heterogeneity; Genomic Instability; Heterozygote; Humans; Hypomorphic; Infant; Molecular Sequence Data; Mutation; Nuclear Proteins - genetics; Nuclear Proteins - immunology; Radiosensitivity; SCID; Severe Combined Immunodeficiency - genetics; Severe Combined Immunodeficiency - immunology; Severe Combined Immunodeficiency - pathology; Siblings; V(D)J Recombination - immunology; Artemis; DCLRE1C; Radiosensitivity; Combined immunodeficiency; Hypomorphic; SCID
• ISSN: 1521-6616; 1521-7035
• DOI: 10.1016/j.clim.2013.08.006

Abstract Defective V(D)J recombination and DNA double-strand break (DSB) repair severely impair the development of T-lymphocytes and B-lymphocytes. Most patients manifest a severe combined immunodeficiency during infancy. We report 2 siblings with combined immunodeficiency (CID) and immunodysregulation caused by compound heterozygous Artemis mutations, including an exon 1–3 deletion generating a null allele, and a missense change (p.T71P). Skin fibroblasts demonstrated normal DSB repair by gamma-H2AX analysis, supporting the predicted hypomorphic nature of the p.T71P allele. In addition to these two patients, 12 patients with Artemis-deficient CID were previously reported. All had significant morbidities including recurrent infections, autoimmunity, EBV-associated lymphoma, and carcinoma despite having hypomorphic mutants with residual Artemis expression, V(D)J recombination or DSB repair capacity. Nine patients underwent stem cell transplant and six survived, while four patients who did not receive transplant died. The progressive nature of immunodeficiency and genomic instability accounts for poor survival, and early HSCT should be considered.