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Whole-exome sequencing of T- B+ severe combined immunodeficiency in Egyptian infants, JAK3 predominance and novel variants.

Authors
  • El Hawary, R1
  • Meshaal, S1
  • Mauracher, A A2
  • Opitz, L3
  • Abd Elaziz, D4
  • Lotfy, S4
  • Eldash, A1
  • Boutros, J4
  • Galal, N4
  • Pachlopnik Schmid, J2
  • Elmarsafy, A4
  • 1 Faculty of Medicine, Clinical Pathology Department, Cairo University, Cairo, Egypt. , (Egypt)
  • 2 Division of Immunology, University Children's Hospital Zurich, Zurich, Switzerland. , (Switzerland)
  • 3 ETH Zurich, Functional Genomics Center Zürich, University of Zurich, Zurich, Switzerland. , (Switzerland)
  • 4 Faculty of Medicine, Pediatrics Department, Cairo University, Cairo, Egypt. , (Egypt)
Type
Published Article
Journal
Clinical & Experimental Immunology
Publisher
Wiley (Blackwell Publishing)
Publication Date
Mar 01, 2021
Volume
203
Issue
3
Pages
448–457
Identifiers
DOI: 10.1111/cei.13536
PMID: 33040328
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Severe combined immunodeficiency (SCID) is fatal if not treated with immune reconstitution. In Egypt, T- B+ SCID accounts for 38·5% of SCID diagnoses. An accurate genetic diagnosis is essential for choosing appropriate treatment modalities and for offering genetic counseling to the patient's family. The objectives of this study were to describe the clinical, immunological and molecular characteristics of a cohort of twenty Egyptian patients with T- B+ SCID. The initial diagnosis (based on clinical features and flow cytometry) was followed by molecular investigation (whole-exome sequencing). All patients had the classic clinical picture for SCID, including failure to thrive (n = 20), oral candidiasis (n = 17), persistent diarrhea (n = 14), pneumonia (n = 13), napkin dermatitis (n = 10), skin rash (n = 7), otitis media (n = 3) and meningitis (n = 2). The onset of manifestations was at the age of 2·4 ± 1·6 months and diagnosis at the age of 6·7 ± ·5 months, giving a diagnostic delay of 4·3 months. JAK3 gene variants were most frequent (n = 12) with three novel variants identified, followed by IL2Rγ variants (n = 6) with two novel variants. IL7Rα and CD3ε variants were found once, with a novel variant each. T- B+ NK- SCID accounted for approximately 90% of the Egyptian patients with T- B+ SCID. Of these T- B+ NK- SCID cases, 60% were autosomal recessive syndromes caused by JAK3 mutations and 30% were X-linked syndromes. It might be useful to sequence the JAK3 gene (i.e. targeted Sanger sequencing) in all T- B+ SCID patients, especially after X-linked SCID has been ruled out. Hence, no more than 10% of T- B+ SCID patients might require next-generation for a molecular diagnosis. © 2020 British Society for Immunology.

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