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Pathogenic NFKB2 variant in the ankyrin repeat domain (R635X) causes a variable antibody deficiency.

Published version
Peer-reviewed

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Type

Article

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Authors

Tuijnenburg, Paul 
de Bree, Godelieve J 
Savic, Sinisa 
Jansen, Machiel H 

Abstract

Genetic studies are identifying an increasing number of monogenic causes of Common Variable Immunodeficiency (CVID). Pathogenic variants in the C-terminus of NFKB2 have been identified in the subset of CVID patients whose immunodeficiency is associated with ectodermal dysplasia and central adrenal insufficiency. We describe 2 unrelated CVID pedigrees with 4 cases of pathogenic stop gain variants (c.1903C > T) in the ankyrin repeat domain (ARD) of NF-κB2, leading to a premature truncation of the protein at p.Arg635Term (R635X). By immunophenotyping and functional ex vivo B- and T-cell experiments we characterized the variant by reduced class-switched memory B-cell counts and immature plasmablasts, unable to produce IgG and IgA. Features of a poor proliferative T-cell response and reduced expansion of CD4+CXCR5+ T cells was only observed in the two clinically affected index cases without any clear clinical correlate. In conclusion, pathogenic stop variants in the ARD of NFKB2 can cause 'infection-only' CVID with an abnormal B-cell phenotype and a variable clinical penetrance.

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Keywords

B cells, Common variable immunodeficiency, NFKB2, T cells, Adrenal Insufficiency, Ankyrin Repeat, B-Lymphocytes, Cells, Cultured, Common Variable Immunodeficiency, Ectodermal Dysplasia, Female, Humans, Immunoglobulin Class Switching, Immunologic Memory, Immunophenotyping, Lymphocyte Activation, Male, Mutation, NF-kappa B p52 Subunit, Pedigree, Receptors, CXCR5, T-Lymphocytes

Journal Title

Clin Immunol

Conference Name

Journal ISSN

1521-6616
1521-7035

Volume Title

203

Publisher

Elsevier BV
Sponsorship
Cambridge University Hospitals NHS Foundation Trust (CUH) (BRC 2012-2017)
Medical Research Council (MR/L006197/1)