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Al Shehri T, Gilmour K, Gothe F, Loughlin S, Bibi S, Rowan AD, Grainger A, Mohanadas T, Cant AJ, Slatter MA, Hambleton S, Lilic D, Leahy TR. Novel Gain-of-Function Mutation in Stat1 Sumoylation Site Leads to CMC/CID Phenotype Responsive to Ruxolitinib. J Clin Immunol 2019; 39:776-785. [PMID: 31512162 DOI: 10.1007/s10875-019-00687-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 09/02/2019] [Indexed: 10/26/2022]
Abstract
Mutations in the coiled-coil and DNA-binding domains of STAT1 lead to delayed STAT1 dephosphorylation and subsequently gain-of-function. The associated clinical phenotype is broad and can include chronic mucocutaneous candidiasis (CMC) and/or combined immunodeficiency (CID). We report a case of CMC/CID in a 10-year-old boy due to a novel mutation in the small ubiquitin molecule (SUMO) consensus site at the C-terminal region of STAT1 leading to gain-of-function by impaired sumoylation. Immunodysregulatory features of disease improved after Janus kinase inhibitor (jakinib) treatment. Functional testing after treatment confirmed reversal of the STAT1 hyper-phosphorylation and downstream transcriptional activity. IL-17 and IL-22 production was, however, not restored with jakinib therapy (ruxolitinib), and the patient remained susceptible to opportunistic infection. In conclusion, a mutation in the SUMO consensus site of STAT1 can lead to gain-of-function that is reversible with jakinib treatment. However, full immunocompetence was not restored, suggesting that this treatment strategy might serve well as a bridge to definitive therapy such as hematopoietic stem cell transplant rather than a long-term treatment option.
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Affiliation(s)
- Tariq Al Shehri
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
- Department of Pathology & Laboratory Medicine, Immunology Lab, King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Kimberly Gilmour
- Department of Immunology, Camelia Botnar Laboratories, Great Ormond Street Hospital for Children, London, UK
| | - Florian Gothe
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Sam Loughlin
- Regional Molecular Genetics Laboratory, Great Ormond Street Hospital for Children, London, UK
| | - Shahnaz Bibi
- Regional Molecular Genetics Laboratory, Great Ormond Street Hospital for Children, London, UK
| | - Andrew D Rowan
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Angela Grainger
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Thivytra Mohanadas
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew J Cant
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
- Department of Paediatric Immunology and BMT, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Mary A Slatter
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
- Department of Paediatric Immunology and BMT, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Sophie Hambleton
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
- Department of Paediatric Immunology and BMT, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Desa Lilic
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Timothy R Leahy
- Department of Paediatric Immunology and Infectious Diseases, Children's Health Ireland, Crumlin, Dublin, D12 N512, Ireland.
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