Genetic Markers on Chromosome 19P and Prenatal Diagnosis of HLA Class II-Deficient Combined Immunodeficiency

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Genetic Markers on Chromosome 19P and Prenatal Diagnosis of HLA Class II-Deficient Combined Immunodeficiency 0031-3998/9513805·0812$03.00/0 PEDIATRIC RESEARCH Vol. 38, No.5, 1995 Copyright © 1995 International Pediatric Research Foundation, Inc. Printed ill U.S.A. Genetic Markers on Chromosome 19p and Prenatal Diagnosis of HLA Class II-Deficient Combined Immunodeficiency HANS-HEINRICH FORSTER, RALPH WASCH, TOBIAS KRETSCHMAR, OIETMAR MISCHKE, BARBARA UCHANSKA-ZIEGLER, ANDREAS ZIEGLER, MARKUS SCHMITT, AND HANS-ULRICH WAHN lnstitut fiir Experimentelle Onkologie und Transplantationsmedizin {H-HF., R.W., T.K., D.M., B.ti.z. A.Z.] and Kinderklinik und -Poliklinik (M.S ., H-U. W.], Universitdtsklinikum Rudolf Yirchow, Freie Universitiit Berlin, D-J4050 Berlin ABST& cr HLA class II-deficient combined immunodeficiency (CID) is 01 9S177. These data may offer the possibility of a rapid and an inherited disease characterized by a total lack of HLA class II early prenatal diagnosis of a subgroup of patients with HLA class gene expression, due to a regulatory defect affecting these genes. II-deficient CID. (Pediatr Res 38: 812-816, 1995) In the family investigated the disease phenotype occurs parallel to an abnormal structural feature of the C023 antigen. We sequenced parts of the FCER2 gene coding for C023 and found Abbreviations a restriction fragment length polymorphism (RFLP) that coseg­ CID, combined immunodeficiency regates with the disease. Analysis of recombinant haplotypcs by PCR, polymerase chain reaction microsatcllites mapping to the chromosomal region 19p13.3 SSCP, single-strand conformation polymorphism suggests that the disease locus maps between FCER2 and the RFLP, restriction fragment length polymorphisms microsatellite marker 0 19S424, probably close to 01 9S216 and FACS, fluorescence-activated cell sorter In clas s II-deficient cm the HLA class II genes are not spondingly, several cis-acting elem ents have been identified in transcribed, and expression of HLA class I antigens on the cell the promoter regions of HLA class II genes (6). surface is also reduced (1). The clini cal consequences are Fusion experiments among several cell lines from patients as hypo- or aga mmaglobulinemia and impaired cell-mediated we ll as in vitro ge nerated mutant cell lines displaying the HLA immunity resulting in repe ated, severe infections and intracta­ class Il-d eficient phenotype have established four different ble diarrhea with dystrophy caused by malab sorption (2). complementation groups (7). In three of thes e complementa­ Currently, the only cur ative therap y is bone marrow transplan­ tion groups all class II promoter elements seem to be unoccu­ tation, whereas under symptomatical therapy most patients die pied in vivo although the currently known facto rs that recog­ between the age of 6 mo and 5 y (3). nize HLA class II promoter elements can be detected in vitro The disease is inherited as an auto somal recessive trait with (8). a high degree of consanguinity. Although none of the patients The fourth complementation group exhibits norm al binding expresses HLA class II mRNA, the genetic defect does not of promoter elements by their respective proteins. A trans­ segregate with the HLA complex. Hence, these observations actin g factor term ed CIITA has been isolated recently. It has suggest a defect in class II regulatory genes which are unlinked been shown that HLA class II expression can be restored in to the major histo compatibility complex (4) encoding, for cells belonging to this group (9) upon transfection with CIITA exa mple, class II promoter-binding proteins (5). cDNA, but not in a cell line established from a deceased class HLA class II antigens have a restricted tissue distribution, II-Cm pati ent of the famil y studied. their expression is under tight transcriptional control and can EBV-transformed cell lines established from the affected be induced by various stimuli, e.g. by interferon-yo Corre- children of this famil y, but not from the healthy family mem­ bers, show an abnormality in their CD23 antigen. Although it reacts normally with other antibodies directed against CD23, it is not recognized by the MAb TVI (10). If this variation Received for rapid publicati on June 2, 1995; accepted July 17, 1995. Corresponden ce: Hans-Ulrich Wahn, Kinderklinik und -Poliklinik, Universitatsklini­ reflects a genetic polymorphism in the CD23 gene (FCER2), it kum Rudolf Virchow, Freie Universitat Berlin, Heubnerweg 6, D-14050 Berlin, Germany. would suggest link age between the class II regul atory gene RUNNING TITLE CLASS II-DEFICIENT cm ON CHROMOSOME 19 813 defect and FCER2, which has been mapped to chromosome protracted diarrhea, recurrent respiratory infections, and severe 19p13.3 (11). To test this hypothesis, we have analyzed the malabsorption leading to failure to thrive. Agammaglobuline­ CD23 gene and several highly polymorphic markers mapping mia developed after 3 mo, and IgG was substituted. Parenteral to the 19p13.3 region in the disease family. nutrition was necessary. B cell as well as T cell count was inconspicious. Severe cm classified as MHC class II defi­ METHODS ciency was diagnosed by a immunorosette-forming technique and by immunohistochemical staining with anti-HLA-DR General. HLA class II antigens were determined by fluo­ mAB. He died at an age of 20 mo, after a sudden attack with rescence-activated cell cytometry. DNA and RNA were iso­ dyspnea, cyanosis, and bradycardia, despite immediate cardio­ lated by standard procedures (12) from cells of both parents, pulmonary resuscitation. Septic shock and pulmonary embo­ three healthy children, two of the affected children, and a lism were mainly discussed as the differential diagnosis. chorionic villi sample and fetal blood of an umbilical cord In the first affected girl the same clinical problems occurred. puncture from the pregnant mother. Agammaglobulinemi a and immunologic findings led, as in the cDNA was synthesized and amplified using the GENE Amp affected brother, to the diagnosis of MHC class II deficiency. RNA PCR Kit (Perkin-Elmer, Norwalk, CT) according to the Bone marrow transplantation was planned and performed. She manufacturer's protocol. PCR products were sequenced di­ died during a severe sepsis 1 wk after haploidentical bone rectly with the Cycle Sequencing Kit (Perkin-Elmer). SSCP marrow transplantation in the 5th y of life. analysis was done as described previously (13). MHC class II deficiency could be diagnosed by FACScan Analysis ofthe FCER2 locus. Oligonucleotide primers used analysis in the second affected girl immediately after birth, are listed in Table 1. The determined RFLP were tested for all before clinical symptoms occurred. The immunologic findings family members by PCR amplification using the primers showed a complete lack of HLA class II molecule expression CD23-1 up and CD23-1 down for BstNI or CD23-3 up and on B lymphocytes and activated T lymphocytes and the ab­ CD23-4 down for Hpall RFLP. Amplification reactions con­ sence of serum immunoglobulins, as well as no in vitro re­ tained 100 ng of genomic DNA and 200 nM of each oligonu­ sponses to specific antigens. Haploidentical bone marrow cleotide primer in a 50-fl,L reaction volume. The reactions transplantation was performed at the age of 5 mo. The father were run for 35 cycles, 1 min each at 94, 60, and n °c. PCR served as donor. After transplantation a chimeric pattern of products were digested overnight with BstNI or Hpall restric­ MHC class II-negative and MHC class II-positive cells was tion endonuclease, separated on a 15% polyacrylamide gel present in the peripheral blood of the child. Delayed hypersen­ (160 X 140 x 0.75 mm), and detected by silver staining. sitivity skin tests became positive for tetanus, and diphtheria Microsatellite analysis. Genomic DNA was amplified with antigen as well as tetanus antigen-induced lymphocyte prolif­ the highly polymorphic microsatellite markers D19S247 (14), eration showed normal values. Ig production remained nega­ D19S209 (15), D19S424 (16) D19S216 (15), D19S406 (16), tive and IgG was given further on. Despite the improved D19S413 (16), D19S221 (15), D19S226 (15), D19S177 (17), cellular immunity gastrointestinal symptoms (diarrhea, malab­ UT486 (18), and LIPE (19) under conditions given in the sorption) persisted. At last the girl died during a severe septic respective references. Products were analyzed by native or infection with different Gram-negative rods and Candida albi­ denaturing polyacrylamide gel electrophoresis or by SSCP. cans. We isolated DNA and RNA from cells of both parents, three RESULTS healthy children (C1-C3), two of the affected children (C4 and In the consanguineous family studied (parents are cousins), C5), and a chorionic villi sample and fetal blood of an umbil­ two girls and one boy were affected by MHC class II defi­ ical cord puncture from the pregnant mother (C6) (Fig. 1a). ciency. Three out of six siblings are healthy (two girls and one Cells of C6 showed normal expression of HLA class II anti­ boy). gens. The affected son was born healthy and of normal weight To analyze the nature of the aberrant Ti n epitope on CD23, without any problems. After the neonatal period he developed we amplified parts of the CD23 cDNA by PCR using primers that were deduced from the published sequence (20, 21). After Table 1. Oligonucleotide primers used fo r PCR, RNA-PCR, and restriction enzyme digestion to yield fragments smaller than direct sequencing of FCER2 300 bp, the products were examined by SSCP analysis. Frag­ Product ments showing heterozygosity in the parents were further Denotation Sequence (5' -> 3') length (bp) examined by direct sequencing. We found two transitions, the 62 CD23- 1 up CGGGAGAATCCAAGCAGGACCG first being located in exon 4 causing a Arg Trp exchange 266 and creating a new BstNI restriction site. The second point CD23-1 down TGCGCCATCTGGTCACCG mutation, located in exon 9, causes an amino acid exchange CD23-2 up GGAACGTCTC TCAAGTTTCCAAGAAC Arg188 GIn (Fig. I c) and, concurrently, the destruction of a 449 CD23-2 down GGTCAGGAAGTCCTGCTCCTCC Hpall restriction site.
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