Exploring genetic defects in adults who were clinically diagnosed as severe combined immune deficiency during infancy

Ido Somekh, Atar Lev, Ortal Barel, Yu Nee Lee, Ayal Hendel, Amos J. Simon, Raz Somech*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Genetic diagnostic tools including whole-exome sequencing (WES) have advanced our understanding in human diseases and become common practice in diagnosing patients with suspected primary immune deficiencies. Establishing a genetic diagnosis is of paramount importance for tailoring adequate therapeutic regimens, including identifying the need for hematopoietic stem cell transplantation (HSCT) and genetic-based therapies. Here, we genetically studied two adult patients who were clinically diagnosed during infancy with severe combined immune deficiency (SCID). Two unrelated patients, both of consanguineous kindred, underwent WES in adulthood, 2 decades after their initial clinical manifestations. Upon clinical presentation, immunological workup was performed, which led to a diagnosis of SCID. The patients presented during infancy with failure to thrive, generalized erythematous rash, and recurrent gastrointestinal and respiratory tract infections, including episodes of Pneumocystis pneumonia infection and Candida albicans fungemia. Hypogammaglobulinemia and T-cell lymphopenia were detected. Both patients were treated with a 10/10 HLA matched sibling donor unconditioned HSCT. Retrospective genetic workup revealed homozygous bi-allelic mutations in IL7RA in one patient and in RAG2 in the other. Our study exemplifies the impact of retrospectively establishing a genetic diagnosis. Pinpointing the genetic cause raises several issues including optimized surveillance and treatment, understanding disease mechanisms and outcomes, future family planning, and social and psychological considerations.

Original languageEnglish
Pages (from-to)145-152
Number of pages8
JournalImmunologic Research
Volume69
Issue number2
DOIs
StatePublished - Apr 2021

Funding

FundersFunder number
Jeffrey Modell Foundation
Israel Science Foundation3115/19
Ministry of Health, State of Israel

    Keywords

    • IL7RA
    • IL7Rα
    • PIDs
    • Primary immunodeficiency
    • RAG2
    • Retrospect
    • SCID
    • Severe combined immunodeficiency
    • WES

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