Monozygotic Twins Concordant for Common Variable Immunodeficiency: Strikingly Similar Clinical and Immune Profile Associated With a Polygenic Burden
FRONTIERS IN IMMUNOLOGY
Authors: Silva, Susana L.; Fonseca, Mariana; Pereira, Marcelo L. M.; Silva, Sara P.; Barbosa, Rita R.; Serra-Caetano, Ana; Blanco, Elena; Rosmaninho, Pedro; Perez-Andres, Martin; Sousa, Ana Berta; Raposo, Alexandre A. S. F.; Gama-Carvalho, Margarida; Victorino, Rui M.; Hammarstrom, Lennart; de Sousa, Ana E.
Abstract
Monozygotic twins provide a unique opportunity to better understand complex genetic diseases and the relative contribution of heritable factors in shaping the immune system throughout life. Common Variable Immunodeficiency Disorders (CVID) are primary antibody defects displaying wide phenotypic and genetic heterogeneity, with monogenic transmission accounting for only a minority of the cases. Here, we report a pair of monozygotic twins concordant for CVID without a family history of primary immunodeficiency. They featured a remarkably similar profile of clinical manifestations and immunological alterations at diagnosis (established at age 37) and along the subsequent 15 years of follow-up. Interestingly, whole-exome sequencing failed to identify a monogenic cause for CVID, but unraveled a combination of heterozygous variants, with a predicted deleterious impact. These variants were found in genes involved in relevant immunological pathways, such as JUN, PTPRC, TLR1, ICAM1, and JAK3. The potential for combinatorial effects translating into the observed disease phenotype is inferred from their roles in immune pathways, namely in T and B cell activation. The combination of these genetic variants is also likely to impose a significant constraint on environmental influences, resulting in a similar immunological phenotype in both twins, despite exposure to different living conditions. Overall, these cases stress the importance of integrating NGS data with clinical and immunological phenotypes at the single-cell level, as provided by multi-dimensional flow-cytometry, in order to understand the complex genetic landscape underlying the vast majority of patients with CVID, as well as those with other immunodeficiencies.
A CD45 polymorphism associated with abnormal splicing is absent in African populations
IMMUNOGENETICS
Authors: Tchilian, EZ; Dawes, R; Ramaley, PA; Whitworth, JA; Yuldasheva, N; Wells, RS; Watera, C; French, N; Gilks, CF; Kunachiwa, W; Ruzibakiev, R; Leetrakool, N; Carrington, CVF; Ramdath, DD; Gotch, F; Stephens, HA; Hill, AV; Beverley, PCL
Abstract
The CD45 antigen is essential for normal antigen receptor-mediated signalling in lymphocytes, and different patterns of splicing of CD45 are associated with distinct functions in lymphocytes. Abnormal CD45 splicing has been recognized in humans, caused by a C77G transversion in the gene encoding CD45 (PTPRC). Recently the C77G poly morph ism has been associated with multiple sclerosis and increased susceptibility to HIV-1 infection. These studies suggest that the regulation of CD45 splicing may be critical for the proper function of the immune system. Because of these data we examined the frequency of the C77G allele in African and Asian populations from countries with high or low prevalence of HIV infection. Here we report that the variant CD45 C77G allele is absent in African populations. We further show that populations living in the Pamir mountains of Central Asia have a very high prevalence of the C77G variant.