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Göransdotter Ericson K, Fadeel B, Nilsson-Ardnor S, Söderhäll C, Samuelsson A, Janka G, Schneider M, Gürgey A, Yalman N, Révész T, Egeler RM, Jahnukainen K, Storm-Mathiesen I, Haraldsson Á, Poole J, de Saint Basile G, Nordenskjöld M, Henter JI. Spectrum of perforin gene mutations in familial hemophagocytic lymphohistiocytosis. Am J Hum Genet 2001; 68:590-7. [PMID: 11179007 PMCID: PMC1274472 DOI: 10.1086/318796] [Citation(s) in RCA: 168] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2000] [Accepted: 01/02/2001] [Indexed: 11/03/2022] Open
Abstract
Familial hemophagocytic lymphohistiocytosis (FHL) is an autosomal recessive disease of early childhood characterized by nonmalignant accumulation and multivisceral infiltration of activated T lymphocytes and histiocytes (macrophages). Cytotoxic T and natural killer (NK) cell activity is markedly reduced or absent in these patients, and mutations in a lytic granule constituent, perforin, were recently identified in a number of FHL individuals. Here, we report a comprehensive survey of 34 additional patients with FHL for mutations in the coding region of the perforin gene and the relative frequency of perforin mutations in FHL. Perforin mutations were identified in 7 of the 34 families investigated. Six children were homozygous for the mutations, and one patient was a compound heterozygote. Four novel mutations were detected: one nonsense, two missense, and one deletion of one amino acid. In four families, a previously reported mutation at codon 374, causing a premature stop codon, was identified, and, therefore, this is the most common perforin mutation identified so far in FHL patients. We found perforin mutations in 20% of all FHL patients investigated (7/34), with a somewhat higher prevalence, approximately 30% (6/20), in children whose parents originated from Turkey. No other correlation between the type of mutation and the phenotype of the patients was evident from the present study. Our combined results from mutational analysis of 34 families and linkage analysis of a subset of consanguineous families indicate that perforin mutations account for 20%-40% of the FHL cases and the FHL 1 locus on chromosome 9 for approximately 10%, whereas the major part of the FHL cases are caused by mutations in not-yet-identified genes.
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Affiliation(s)
- Kim Göransdotter Ericson
- Childhood Cancer Research Unit, Department of Pediatric Hematology and Oncology, Karolinska Hospital, Department of Molecular Medicine, and Institute of Environmental Medicine, Division of Toxicology, Karolinska Institutet, Stockholm; Department of Clinical Genetics, Umeå University Hospital, Umeå, Sweden; Department of Hematology and Oncology, Children`s University Hospital, Hamburg; Experimental Anesthesiology, University of Ulm, Ulm, Germany; Department of Pediatric Hematology, Hacettepe University, Ankara; Department of Pediatric Oncology, Istanbul School of Medicine, Istanbul; Department of Haematology-Oncology, Wilhelmina Hospital for Children, Utrecht; Department of Pediatrics, Leiden University Medical Center, Leiden; Department of Pediatrics, University of Turku, Turku, Finland; Department of Pediatrics, National Hospital, Oslo; Department of Paediatrics, University Hospital, Reykjavik; Department of Paediatric Haematology/Oncology, Johannesburg Hospital, Johannesburg; and Unité de Recherches sur le Dévelopement Normal et Pathologique du Systéme Immunitaire INSERM U429, Hôpital Necker-Enfants Malades, Paris
| | - Bengt Fadeel
- Childhood Cancer Research Unit, Department of Pediatric Hematology and Oncology, Karolinska Hospital, Department of Molecular Medicine, and Institute of Environmental Medicine, Division of Toxicology, Karolinska Institutet, Stockholm; Department of Clinical Genetics, Umeå University Hospital, Umeå, Sweden; Department of Hematology and Oncology, Children`s University Hospital, Hamburg; Experimental Anesthesiology, University of Ulm, Ulm, Germany; Department of Pediatric Hematology, Hacettepe University, Ankara; Department of Pediatric Oncology, Istanbul School of Medicine, Istanbul; Department of Haematology-Oncology, Wilhelmina Hospital for Children, Utrecht; Department of Pediatrics, Leiden University Medical Center, Leiden; Department of Pediatrics, University of Turku, Turku, Finland; Department of Pediatrics, National Hospital, Oslo; Department of Paediatrics, University Hospital, Reykjavik; Department of Paediatric Haematology/Oncology, Johannesburg Hospital, Johannesburg; and Unité de Recherches sur le Dévelopement Normal et Pathologique du Systéme Immunitaire INSERM U429, Hôpital Necker-Enfants Malades, Paris
| | - Sofie Nilsson-Ardnor
- Childhood Cancer Research Unit, Department of Pediatric Hematology and Oncology, Karolinska Hospital, Department of Molecular Medicine, and Institute of Environmental Medicine, Division of Toxicology, Karolinska Institutet, Stockholm; Department of Clinical Genetics, Umeå University Hospital, Umeå, Sweden; Department of Hematology and Oncology, Children`s University Hospital, Hamburg; Experimental Anesthesiology, University of Ulm, Ulm, Germany; Department of Pediatric Hematology, Hacettepe University, Ankara; Department of Pediatric Oncology, Istanbul School of Medicine, Istanbul; Department of Haematology-Oncology, Wilhelmina Hospital for Children, Utrecht; Department of Pediatrics, Leiden University Medical Center, Leiden; Department of Pediatrics, University of Turku, Turku, Finland; Department of Pediatrics, National Hospital, Oslo; Department of Paediatrics, University Hospital, Reykjavik; Department of Paediatric Haematology/Oncology, Johannesburg Hospital, Johannesburg; and Unité de Recherches sur le Dévelopement Normal et Pathologique du Systéme Immunitaire INSERM U429, Hôpital Necker-Enfants Malades, Paris
| | - Cilla Söderhäll
- Childhood Cancer Research Unit, Department of Pediatric Hematology and Oncology, Karolinska Hospital, Department of Molecular Medicine, and Institute of Environmental Medicine, Division of Toxicology, Karolinska Institutet, Stockholm; Department of Clinical Genetics, Umeå University Hospital, Umeå, Sweden; Department of Hematology and Oncology, Children`s University Hospital, Hamburg; Experimental Anesthesiology, University of Ulm, Ulm, Germany; Department of Pediatric Hematology, Hacettepe University, Ankara; Department of Pediatric Oncology, Istanbul School of Medicine, Istanbul; Department of Haematology-Oncology, Wilhelmina Hospital for Children, Utrecht; Department of Pediatrics, Leiden University Medical Center, Leiden; Department of Pediatrics, University of Turku, Turku, Finland; Department of Pediatrics, National Hospital, Oslo; Department of Paediatrics, University Hospital, Reykjavik; Department of Paediatric Haematology/Oncology, Johannesburg Hospital, Johannesburg; and Unité de Recherches sur le Dévelopement Normal et Pathologique du Systéme Immunitaire INSERM U429, Hôpital Necker-Enfants Malades, Paris
| | - AnnaCarin Samuelsson
- Childhood Cancer Research Unit, Department of Pediatric Hematology and Oncology, Karolinska Hospital, Department of Molecular Medicine, and Institute of Environmental Medicine, Division of Toxicology, Karolinska Institutet, Stockholm; Department of Clinical Genetics, Umeå University Hospital, Umeå, Sweden; Department of Hematology and Oncology, Children`s University Hospital, Hamburg; Experimental Anesthesiology, University of Ulm, Ulm, Germany; Department of Pediatric Hematology, Hacettepe University, Ankara; Department of Pediatric Oncology, Istanbul School of Medicine, Istanbul; Department of Haematology-Oncology, Wilhelmina Hospital for Children, Utrecht; Department of Pediatrics, Leiden University Medical Center, Leiden; Department of Pediatrics, University of Turku, Turku, Finland; Department of Pediatrics, National Hospital, Oslo; Department of Paediatrics, University Hospital, Reykjavik; Department of Paediatric Haematology/Oncology, Johannesburg Hospital, Johannesburg; and Unité de Recherches sur le Dévelopement Normal et Pathologique du Systéme Immunitaire INSERM U429, Hôpital Necker-Enfants Malades, Paris
| | - Gritta Janka
- Childhood Cancer Research Unit, Department of Pediatric Hematology and Oncology, Karolinska Hospital, Department of Molecular Medicine, and Institute of Environmental Medicine, Division of Toxicology, Karolinska Institutet, Stockholm; Department of Clinical Genetics, Umeå University Hospital, Umeå, Sweden; Department of Hematology and Oncology, Children`s University Hospital, Hamburg; Experimental Anesthesiology, University of Ulm, Ulm, Germany; Department of Pediatric Hematology, Hacettepe University, Ankara; Department of Pediatric Oncology, Istanbul School of Medicine, Istanbul; Department of Haematology-Oncology, Wilhelmina Hospital for Children, Utrecht; Department of Pediatrics, Leiden University Medical Center, Leiden; Department of Pediatrics, University of Turku, Turku, Finland; Department of Pediatrics, National Hospital, Oslo; Department of Paediatrics, University Hospital, Reykjavik; Department of Paediatric Haematology/Oncology, Johannesburg Hospital, Johannesburg; and Unité de Recherches sur le Dévelopement Normal et Pathologique du Systéme Immunitaire INSERM U429, Hôpital Necker-Enfants Malades, Paris
| | - Marion Schneider
- Childhood Cancer Research Unit, Department of Pediatric Hematology and Oncology, Karolinska Hospital, Department of Molecular Medicine, and Institute of Environmental Medicine, Division of Toxicology, Karolinska Institutet, Stockholm; Department of Clinical Genetics, Umeå University Hospital, Umeå, Sweden; Department of Hematology and Oncology, Children`s University Hospital, Hamburg; Experimental Anesthesiology, University of Ulm, Ulm, Germany; Department of Pediatric Hematology, Hacettepe University, Ankara; Department of Pediatric Oncology, Istanbul School of Medicine, Istanbul; Department of Haematology-Oncology, Wilhelmina Hospital for Children, Utrecht; Department of Pediatrics, Leiden University Medical Center, Leiden; Department of Pediatrics, University of Turku, Turku, Finland; Department of Pediatrics, National Hospital, Oslo; Department of Paediatrics, University Hospital, Reykjavik; Department of Paediatric Haematology/Oncology, Johannesburg Hospital, Johannesburg; and Unité de Recherches sur le Dévelopement Normal et Pathologique du Systéme Immunitaire INSERM U429, Hôpital Necker-Enfants Malades, Paris
| | - Aytemiz Gürgey
- Childhood Cancer Research Unit, Department of Pediatric Hematology and Oncology, Karolinska Hospital, Department of Molecular Medicine, and Institute of Environmental Medicine, Division of Toxicology, Karolinska Institutet, Stockholm; Department of Clinical Genetics, Umeå University Hospital, Umeå, Sweden; Department of Hematology and Oncology, Children`s University Hospital, Hamburg; Experimental Anesthesiology, University of Ulm, Ulm, Germany; Department of Pediatric Hematology, Hacettepe University, Ankara; Department of Pediatric Oncology, Istanbul School of Medicine, Istanbul; Department of Haematology-Oncology, Wilhelmina Hospital for Children, Utrecht; Department of Pediatrics, Leiden University Medical Center, Leiden; Department of Pediatrics, University of Turku, Turku, Finland; Department of Pediatrics, National Hospital, Oslo; Department of Paediatrics, University Hospital, Reykjavik; Department of Paediatric Haematology/Oncology, Johannesburg Hospital, Johannesburg; and Unité de Recherches sur le Dévelopement Normal et Pathologique du Systéme Immunitaire INSERM U429, Hôpital Necker-Enfants Malades, Paris
| | - Nevin Yalman
- Childhood Cancer Research Unit, Department of Pediatric Hematology and Oncology, Karolinska Hospital, Department of Molecular Medicine, and Institute of Environmental Medicine, Division of Toxicology, Karolinska Institutet, Stockholm; Department of Clinical Genetics, Umeå University Hospital, Umeå, Sweden; Department of Hematology and Oncology, Children`s University Hospital, Hamburg; Experimental Anesthesiology, University of Ulm, Ulm, Germany; Department of Pediatric Hematology, Hacettepe University, Ankara; Department of Pediatric Oncology, Istanbul School of Medicine, Istanbul; Department of Haematology-Oncology, Wilhelmina Hospital for Children, Utrecht; Department of Pediatrics, Leiden University Medical Center, Leiden; Department of Pediatrics, University of Turku, Turku, Finland; Department of Pediatrics, National Hospital, Oslo; Department of Paediatrics, University Hospital, Reykjavik; Department of Paediatric Haematology/Oncology, Johannesburg Hospital, Johannesburg; and Unité de Recherches sur le Dévelopement Normal et Pathologique du Systéme Immunitaire INSERM U429, Hôpital Necker-Enfants Malades, Paris
| | - Tom Révész
- Childhood Cancer Research Unit, Department of Pediatric Hematology and Oncology, Karolinska Hospital, Department of Molecular Medicine, and Institute of Environmental Medicine, Division of Toxicology, Karolinska Institutet, Stockholm; Department of Clinical Genetics, Umeå University Hospital, Umeå, Sweden; Department of Hematology and Oncology, Children`s University Hospital, Hamburg; Experimental Anesthesiology, University of Ulm, Ulm, Germany; Department of Pediatric Hematology, Hacettepe University, Ankara; Department of Pediatric Oncology, Istanbul School of Medicine, Istanbul; Department of Haematology-Oncology, Wilhelmina Hospital for Children, Utrecht; Department of Pediatrics, Leiden University Medical Center, Leiden; Department of Pediatrics, University of Turku, Turku, Finland; Department of Pediatrics, National Hospital, Oslo; Department of Paediatrics, University Hospital, Reykjavik; Department of Paediatric Haematology/Oncology, Johannesburg Hospital, Johannesburg; and Unité de Recherches sur le Dévelopement Normal et Pathologique du Systéme Immunitaire INSERM U429, Hôpital Necker-Enfants Malades, Paris
| | - R. Maarten Egeler
- Childhood Cancer Research Unit, Department of Pediatric Hematology and Oncology, Karolinska Hospital, Department of Molecular Medicine, and Institute of Environmental Medicine, Division of Toxicology, Karolinska Institutet, Stockholm; Department of Clinical Genetics, Umeå University Hospital, Umeå, Sweden; Department of Hematology and Oncology, Children`s University Hospital, Hamburg; Experimental Anesthesiology, University of Ulm, Ulm, Germany; Department of Pediatric Hematology, Hacettepe University, Ankara; Department of Pediatric Oncology, Istanbul School of Medicine, Istanbul; Department of Haematology-Oncology, Wilhelmina Hospital for Children, Utrecht; Department of Pediatrics, Leiden University Medical Center, Leiden; Department of Pediatrics, University of Turku, Turku, Finland; Department of Pediatrics, National Hospital, Oslo; Department of Paediatrics, University Hospital, Reykjavik; Department of Paediatric Haematology/Oncology, Johannesburg Hospital, Johannesburg; and Unité de Recherches sur le Dévelopement Normal et Pathologique du Systéme Immunitaire INSERM U429, Hôpital Necker-Enfants Malades, Paris
| | - Kirsi Jahnukainen
- Childhood Cancer Research Unit, Department of Pediatric Hematology and Oncology, Karolinska Hospital, Department of Molecular Medicine, and Institute of Environmental Medicine, Division of Toxicology, Karolinska Institutet, Stockholm; Department of Clinical Genetics, Umeå University Hospital, Umeå, Sweden; Department of Hematology and Oncology, Children`s University Hospital, Hamburg; Experimental Anesthesiology, University of Ulm, Ulm, Germany; Department of Pediatric Hematology, Hacettepe University, Ankara; Department of Pediatric Oncology, Istanbul School of Medicine, Istanbul; Department of Haematology-Oncology, Wilhelmina Hospital for Children, Utrecht; Department of Pediatrics, Leiden University Medical Center, Leiden; Department of Pediatrics, University of Turku, Turku, Finland; Department of Pediatrics, National Hospital, Oslo; Department of Paediatrics, University Hospital, Reykjavik; Department of Paediatric Haematology/Oncology, Johannesburg Hospital, Johannesburg; and Unité de Recherches sur le Dévelopement Normal et Pathologique du Systéme Immunitaire INSERM U429, Hôpital Necker-Enfants Malades, Paris
| | - Ingebjörg Storm-Mathiesen
- Childhood Cancer Research Unit, Department of Pediatric Hematology and Oncology, Karolinska Hospital, Department of Molecular Medicine, and Institute of Environmental Medicine, Division of Toxicology, Karolinska Institutet, Stockholm; Department of Clinical Genetics, Umeå University Hospital, Umeå, Sweden; Department of Hematology and Oncology, Children`s University Hospital, Hamburg; Experimental Anesthesiology, University of Ulm, Ulm, Germany; Department of Pediatric Hematology, Hacettepe University, Ankara; Department of Pediatric Oncology, Istanbul School of Medicine, Istanbul; Department of Haematology-Oncology, Wilhelmina Hospital for Children, Utrecht; Department of Pediatrics, Leiden University Medical Center, Leiden; Department of Pediatrics, University of Turku, Turku, Finland; Department of Pediatrics, National Hospital, Oslo; Department of Paediatrics, University Hospital, Reykjavik; Department of Paediatric Haematology/Oncology, Johannesburg Hospital, Johannesburg; and Unité de Recherches sur le Dévelopement Normal et Pathologique du Systéme Immunitaire INSERM U429, Hôpital Necker-Enfants Malades, Paris
| | - Ásgeir Haraldsson
- Childhood Cancer Research Unit, Department of Pediatric Hematology and Oncology, Karolinska Hospital, Department of Molecular Medicine, and Institute of Environmental Medicine, Division of Toxicology, Karolinska Institutet, Stockholm; Department of Clinical Genetics, Umeå University Hospital, Umeå, Sweden; Department of Hematology and Oncology, Children`s University Hospital, Hamburg; Experimental Anesthesiology, University of Ulm, Ulm, Germany; Department of Pediatric Hematology, Hacettepe University, Ankara; Department of Pediatric Oncology, Istanbul School of Medicine, Istanbul; Department of Haematology-Oncology, Wilhelmina Hospital for Children, Utrecht; Department of Pediatrics, Leiden University Medical Center, Leiden; Department of Pediatrics, University of Turku, Turku, Finland; Department of Pediatrics, National Hospital, Oslo; Department of Paediatrics, University Hospital, Reykjavik; Department of Paediatric Haematology/Oncology, Johannesburg Hospital, Johannesburg; and Unité de Recherches sur le Dévelopement Normal et Pathologique du Systéme Immunitaire INSERM U429, Hôpital Necker-Enfants Malades, Paris
| | - Janet Poole
- Childhood Cancer Research Unit, Department of Pediatric Hematology and Oncology, Karolinska Hospital, Department of Molecular Medicine, and Institute of Environmental Medicine, Division of Toxicology, Karolinska Institutet, Stockholm; Department of Clinical Genetics, Umeå University Hospital, Umeå, Sweden; Department of Hematology and Oncology, Children`s University Hospital, Hamburg; Experimental Anesthesiology, University of Ulm, Ulm, Germany; Department of Pediatric Hematology, Hacettepe University, Ankara; Department of Pediatric Oncology, Istanbul School of Medicine, Istanbul; Department of Haematology-Oncology, Wilhelmina Hospital for Children, Utrecht; Department of Pediatrics, Leiden University Medical Center, Leiden; Department of Pediatrics, University of Turku, Turku, Finland; Department of Pediatrics, National Hospital, Oslo; Department of Paediatrics, University Hospital, Reykjavik; Department of Paediatric Haematology/Oncology, Johannesburg Hospital, Johannesburg; and Unité de Recherches sur le Dévelopement Normal et Pathologique du Systéme Immunitaire INSERM U429, Hôpital Necker-Enfants Malades, Paris
| | - Geneviève de Saint Basile
- Childhood Cancer Research Unit, Department of Pediatric Hematology and Oncology, Karolinska Hospital, Department of Molecular Medicine, and Institute of Environmental Medicine, Division of Toxicology, Karolinska Institutet, Stockholm; Department of Clinical Genetics, Umeå University Hospital, Umeå, Sweden; Department of Hematology and Oncology, Children`s University Hospital, Hamburg; Experimental Anesthesiology, University of Ulm, Ulm, Germany; Department of Pediatric Hematology, Hacettepe University, Ankara; Department of Pediatric Oncology, Istanbul School of Medicine, Istanbul; Department of Haematology-Oncology, Wilhelmina Hospital for Children, Utrecht; Department of Pediatrics, Leiden University Medical Center, Leiden; Department of Pediatrics, University of Turku, Turku, Finland; Department of Pediatrics, National Hospital, Oslo; Department of Paediatrics, University Hospital, Reykjavik; Department of Paediatric Haematology/Oncology, Johannesburg Hospital, Johannesburg; and Unité de Recherches sur le Dévelopement Normal et Pathologique du Systéme Immunitaire INSERM U429, Hôpital Necker-Enfants Malades, Paris
| | - Magnus Nordenskjöld
- Childhood Cancer Research Unit, Department of Pediatric Hematology and Oncology, Karolinska Hospital, Department of Molecular Medicine, and Institute of Environmental Medicine, Division of Toxicology, Karolinska Institutet, Stockholm; Department of Clinical Genetics, Umeå University Hospital, Umeå, Sweden; Department of Hematology and Oncology, Children`s University Hospital, Hamburg; Experimental Anesthesiology, University of Ulm, Ulm, Germany; Department of Pediatric Hematology, Hacettepe University, Ankara; Department of Pediatric Oncology, Istanbul School of Medicine, Istanbul; Department of Haematology-Oncology, Wilhelmina Hospital for Children, Utrecht; Department of Pediatrics, Leiden University Medical Center, Leiden; Department of Pediatrics, University of Turku, Turku, Finland; Department of Pediatrics, National Hospital, Oslo; Department of Paediatrics, University Hospital, Reykjavik; Department of Paediatric Haematology/Oncology, Johannesburg Hospital, Johannesburg; and Unité de Recherches sur le Dévelopement Normal et Pathologique du Systéme Immunitaire INSERM U429, Hôpital Necker-Enfants Malades, Paris
| | - Jan-Inge Henter
- Childhood Cancer Research Unit, Department of Pediatric Hematology and Oncology, Karolinska Hospital, Department of Molecular Medicine, and Institute of Environmental Medicine, Division of Toxicology, Karolinska Institutet, Stockholm; Department of Clinical Genetics, Umeå University Hospital, Umeå, Sweden; Department of Hematology and Oncology, Children`s University Hospital, Hamburg; Experimental Anesthesiology, University of Ulm, Ulm, Germany; Department of Pediatric Hematology, Hacettepe University, Ankara; Department of Pediatric Oncology, Istanbul School of Medicine, Istanbul; Department of Haematology-Oncology, Wilhelmina Hospital for Children, Utrecht; Department of Pediatrics, Leiden University Medical Center, Leiden; Department of Pediatrics, University of Turku, Turku, Finland; Department of Pediatrics, National Hospital, Oslo; Department of Paediatrics, University Hospital, Reykjavik; Department of Paediatric Haematology/Oncology, Johannesburg Hospital, Johannesburg; and Unité de Recherches sur le Dévelopement Normal et Pathologique du Systéme Immunitaire INSERM U429, Hôpital Necker-Enfants Malades, Paris
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