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The Same IB Mutation in Two Related Individuals Leads to Completely Different Clinical Syndromes

¹ Department of Infectious Diseases, Leiden University Medical Center, 2300 RC Leiden, Netherlands
² Department of Immunohematology and Bloodtransfusion, Leiden University Medical Center, 2300 RC Leiden, Netherlands
³ Department of Pediatrics, Leiden University Medical Center, 2300 RC Leiden, Netherlands
⁴ Department of Immunology, Erasmus Medical Center, Erasmus University, 3015 GE Rotterdam, Netherlands
⁵ Department of Pediatrics, University Medical Center, 6500 HB Nijmegen, Netherlands

Address correspondence to Riny Janssen, Dept. of Infectious Diseases, C5-P Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, Netherlands. Phone: 31-71-526-2204; Fax: 31-71-626-6758; email: C.M.Janssen{at}lumc.nl

Both innate and adaptive immune responses are dependent on activation of nuclear factor B (NF-B), induced upon binding of pathogen-associated molecular patterns to Toll-like receptors (TLRs). In murine models, defects in NF-B pathway are often lethal and viable knockout mice have severe immune defects. Similarly, defects in the human NF-B pathway described to date lead to severe clinical disease. Here, we describe a patient with a hyper immunoglobulin M–like immunodeficiency syndrome and ectodermal dysplasia. Monocytes did not produce interleukin 12p40 upon stimulation with various TLR stimuli and nuclear translocation of NF-B was impaired. T cell receptor–mediated proliferation was also impaired. A heterozygous mutation was found at serine 32 in IB. Interestingly, his father has the same mutation but displays complex mosaicism. He does not display features of ectodermal dysplasia and did not suffer from serious infections with the exception of a relapsing Salmonella typhimurium infection. His monocyte function was impaired, whereas T cell function was relatively normal. Consistent with this, his T cells almost exclusively displayed the wild-type allele, whereas both alleles were present in his monocytes. We propose that the T and B cell compartment of the mosaic father arose as a result of selection of wild-type cells and that this underlies the widely different clinical phenotype.

Key Words: immunodeficiency • IB • monocyte function • T cell activation • infection

Abbreviations used in this paper: IKK, IB kinase; JIA, juvenile idiopathic arthritis; PAMP, pathogen-associated molecular pattern; TLR, Toll-like receptor; TT, tetanus toxoid.

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