DCLRE1C (ARTEMIS) mutations causing phenotypes ranging from atypical severe combined immunodeficiency to mere antibody deficiency

T Volk, U Pannicke, I Reisli… - Human molecular …, 2015 - academic.oup.com
T Volk, U Pannicke, I Reisli, A Bulashevska, J Ritter, A Björkman, AA Schäffer, M Fliegauf…
Human molecular genetics, 2015academic.oup.com
Null mutations in genes involved in V (D) J recombination cause a block in B-and T-cell
development, clinically presenting as severe combined immunodeficiency (SCID).
Hypomorphic mutations in the non-homologous end-joining gene DCLRE1C (encoding
ARTEMIS) have been described to cause atypical SCID, Omenn syndrome, Hyper IgM
syndrome and inflammatory bowel disease—all with severely impaired T-cell immunity. By
whole-exome sequencing, we investigated the molecular defect in a consanguineous family …
Abstract
Null mutations in genes involved in V(D)J recombination cause a block in B- and T-cell development, clinically presenting as severe combined immunodeficiency (SCID). Hypomorphic mutations in the non-homologous end-joining gene DCLRE1C (encoding ARTEMIS) have been described to cause atypical SCID, Omenn syndrome, Hyper IgM syndrome and inflammatory bowel disease—all with severely impaired T-cell immunity. By whole-exome sequencing, we investigated the molecular defect in a consanguineous family with three children clinically diagnosed with antibody deficiency. We identified perfectly segregating homozygous variants in DCLRE1C in three index patients with recurrent respiratory tract infections, very low B-cell numbers and serum IgA levels. In patients, decreased colony survival after irradiation, impaired proliferative response and reduced counts of naïve T cells were observed in addition to a restricted T-cell receptor repertoire, increased palindromic nucleotides in the complementarity determining regions 3 and long stretches of microhomology at switch junctions. Defective V(D)J recombination was complemented by wild-type ARTEMIS protein in vitro. Subsequently, homozygous or compound heterozygous DCLRE1C mutations were identified in nine patients from the same geographic region. We demonstrate that DCLRE1C mutations can cause a phenotype presenting as only antibody deficiency. This novel association broadens the clinical spectrum associated with ARTEMIS mutations. Clinicians should consider the possibility that an immunodeficiency with a clinically mild initial presentation could be a combined immunodeficiency, so as to provide appropriate care for affected patients.
Oxford University Press