Atypical immune phenotype in severe combined immunodeficiency patients with novel mutations in IL2RG and JAK3

Genes Immun. 2020 Nov;21(5):326-334. doi: 10.1038/s41435-020-00111-7. Epub 2020 Sep 14.

Abstract

Mutations in the common gamma chain of the interleukin 2 receptor (IL2RG) or the associated downstream signaling enzyme Janus kinase 3 (JAK3) genes are typically characterized by a T cell-negative, B cell-positive, natural killer (NK) cell-negative (T-B+NK-) severe combined immunodeficiency (SCID) immune phenotype. We report clinical course, immunological, genetic and proteomic work-up of two patients with different novel mutations in the IL-2-JAK3 pathway with a rare atypical presentation of T-B+NK- SCID. Lymphocyte subpopulation revealed significant T cells lymphopenia, normal B cells, and NK cells counts (T-B+NK+SCID). Despite the presence of B cells, IgG levels were low and IgA and IgM levels were undetectable. T-cell proliferation in response to mitogens in patient 1 was very low and T-cell receptor V-beta chain repertoire in patient 2 was polyclonal. Whole-exome sequencing revealed novel mutations in both patients (patient 1-c.923delC frame-shift mutation in the IL2RG gene, patient 2-c.G172A a homozygous missense mutation in the JAK3 gene). Bioinformatic analysis of the JAK3 mutation indicated deleterious effect and 3D protein modeling located the mutation to a surface exposed alpha-helix structure. Our findings help to link between genotype and phenotype, which is a key factor for the diagnosis and treatment of SCID patients.

Publication types

  • Case Reports

MeSH terms

  • Female
  • Humans
  • Infant
  • Interleukin Receptor Common gamma Subunit / genetics*
  • Janus Kinase 3 / chemistry
  • Janus Kinase 3 / genetics*
  • Male
  • Mutation
  • Pedigree
  • Phenotype*
  • Protein Conformation, alpha-Helical
  • Severe Combined Immunodeficiency / genetics*
  • Severe Combined Immunodeficiency / pathology

Substances

  • IL2RG protein, human
  • Interleukin Receptor Common gamma Subunit
  • JAK3 protein, human
  • Janus Kinase 3