Identification of anti–herpes simplex virus antibody–producing B cells in a patient with an atypical RAG1 immunodeficiency

S Kumaki, A Villa, H Asada, S Kawai… - Blood, The Journal …, 2001 - ashpublications.org
S Kumaki, A Villa, H Asada, S Kawai, Y Ohashi, M Takahashi, I Hakozaki, E Nitanai…
Blood, The Journal of the American Society of Hematology, 2001ashpublications.org
Mutations of the RAG1 or RAG2 protein that eliminate their recombination activity result in
TB-severe combined immunodeficiency (SCID), whereas mutations retaining partial
recombination activity lead to Omenn syndrome, a peculiar SCID characterized by increased
host T cells and absence of circulating B cells. The prognosis of this disease is fatal, unless
hematopoietic stem cell transplantation is performed. This study reports a case of atypical
SCID, carrying RAG1 mutations. The patient survived for 6 years without hematopoietic stem …
Mutations of the RAG1 or RAG2 protein that eliminate their recombination activity result in T-B-severe combined immunodeficiency (SCID), whereas mutations retaining partial recombination activity lead to Omenn syndrome, a peculiar SCID characterized by increased host T cells and absence of circulating B cells. The prognosis of this disease is fatal, unless hematopoietic stem cell transplantation is performed. This study reports a case of atypical SCID, carrying RAG1 mutations. The patient survived for 6 years without hematopoietic stem cell transplantation. The missense mutation, tested by in vivo recombination assay, revealed residual recombination activity. By the age of 5 years, the patient developed host B cells, but not T cells, possibly due to engrafted maternal T cells. In addition, the host B cells were able to produce antibodies, including anti–herpes simplex virus–antibodies. The fact that host B cells could produce antibodies in this patient could explain not only the mild phenotype observed but also, at least in part, how patients with Omenn syndrome produce immunoglobulin E and sometimes immunoglobulin M, as the same missense mutation of RAG1 gene has been reported in a patient with Omenn syndrome.
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