A novel missense mutation in the NADPH binding domain of CYBB abolishes the NADPH oxidase activity in a male patient with increased susceptibility to infections
MICROBIAL PATHOGENESIS
Authors: Khan, Taj Ali; Kalsoom, Kalsoom; Iqbal, Asif; Asif, Huma; Rahman, Hazir; Farooq, Syed Omar; Naveed, Hassan; Nasir, Umar; Amin, Muhammad Usman; Hussain, Mubashir; Tipu, Hamid Nawaz; Florea, Andrei
Abstract
Chronic granulomatous disease (CGD) is a primary immunodeficiency caused by mutations in the five structural genes (CYBB, CYBA, NCF1, NCF2, and NCF4) that typically results in a decrease in function or inability to generate a respiratory burst, leading to defective killing of pathogens, including fungi and intracellular bacteria. Mutations in CYBB, encoding the gp91 phox (also known as NOX2) result in X-linked CGD account for approximately 65% of CGD cases. Here, we aimed the characterization of a novel missense mutation c.1226C > A/p.A409E in the CYBB gene in a patient with X-linked CGD. Relevant clinical data of a male patient whose family was positive for XCGD was reviewed. Oxidative burst and NADPH protein expression was evaluated by flow cytometry, while Genetic analysis was performed by Sanger sequencing. Monocyte-derived macrophages (MDMs) were evaluated for their capacity for phagocytosis and growth suppression of the intracellular Mycobacterium tuberculosis (M. tuberculosis). We thus report the absence of an oxidative burst in the phagocytes of the patient. Flow cytometry evaluation revealed a normal expression of NADPH oxidase components in neutrophils and genetic analysis proved the existence of a novel missense c.1226C > A mutation in the CYBB gene resulting in p.A409E. Further, we have showed that the patient's MDMs were unhindered in their ability to take up mycobacteria normally. Instead, the MDMs failed to control the intracellular proliferation of M. tuberculosis, a phenotype that improved in the presence of recombinant human interferon-gamma (rhIFN-gamma). This work expands the genetic spectrum of X-linked CGD and demonstrates improvement in macrophage function in X91(+)CGD patient by rhIFN-gamma. (C) 2016 Elsevier Ltd. All rights reserved.
Inherited p40(phox) deficiency differs from classic chronic granulomatous disease
JOURNAL OF CLINICAL INVESTIGATION
Authors: van de Geer, Annemarie; Nieto-Patlan, Alejandro; Kuhns, Douglas B.; Tool, Anton T. J.; Arias, Andres A.; Bouaziz, Matthieu; de Boer, Martin; Luis Franco, Jose; Gazendam, Roel P.; van Hamme, John L.; van Houdt, Michel; van Leeuwen, Karin; Verkuijlen, Paul J. H.; van den Berg, Timo K.; Alzate, Juan F.; Arango-Franco, Carlos A.; Batura, Vritika; Bernasconi, Andrea R.; Boardman, Barbara; Booth, Claire; Burns, Siobhan O.; Cabarcas, Felipe; Bensussan, Nadine Cerf; Charbit-Henrion, Fabienne; Corveleyn, Anniek; Deswarte, Caroline; Esnaola Azcoiti, Maria; Foell, Dirk; Gallin, John I.; Garces, Carlos; Guedes, Margarida; Hinze, Claas H.; Holland, Steven M.; Hughes, Stephen M.; Ibanez, Patricio; Malech, Harry L.; Meyts, Isabelle; Moncada-Velez, Marcela; Moriya, Kunihiko; Neves, Esmeralda; Oleastro, Matias; Perez, Laura; Rattina, Vimel; Oleaga-Quintas, Carmen; Warner, Neil; Muise, Aleixo M.; Serafin Lopez, Jeanet; Trindade, Eunice; Vasconcelos, Julia; Vermeire, Severine; Wittkowski, Helmut; Worth, Austen; Abel, Laurent; Dinauer, Mary C.; Arkwright, Peter D.; Roos, Dirk; Casanova, Jean-Laurent; Kuijpers, Taco W.; Bustamante, Jacinta
Abstract
Biallelic loss-of-function (LOF) mutations of the NCF4 gene, encoding the p40(phox) subunit of the phagocyte NADPH oxidase, have been described in only 1 patient. We report on 24 p40(phox)-deficient patients from 12 additional families in 8 countries. These patients display 8 different in-frame or out-of-frame mutations of NCF4 that are homozygous in 11 of the families and compound heterozygous in another. When overexpressed in NB4 neutrophil-like cells and EBV-transformed B cells in vitro, the mutant alleles were found to be LOF, with the exception of the p.R58C and c.120_134del alleles, which were hypomorphic. Particle-induced NADPH oxidase activity was severely impaired in the patients' neutrophils, whereas PMAinduced dihydrorhodamine-1,2,3 (DHR) oxidation, which is widely used as a diagnostic test for chronic granulomatous disease (CGD), was normal or mildly impaired in the patients. Moreover, the NADPH oxidase activity of EBV-transformed B cells was also severely impaired, whereas that of mononuclear phagocytes was normal. Finally, the killing of Candida albicans and Aspergillus fumigatus hyphae by neutrophils was conserved in these patients, unlike in patients with CGD. The patients suffer from hyperinflammation and peripheral infections, but they do not have any of the invasive bacterial or fungal infections seen in CGD. Inherited p40(phox) deficiency underlies a distinctive condition, resembling a mild, atypical form of CGD.