Salzer Ulrich, Hagena Tina, Webster David B, Grimbacher Bodo
Division of Rheumatology and Clinical Immunology, Medical School, University Hospital Freiburg, Freiburg, Germany.
Int Arch Allergy Immunol. 2008;147(2):147-51. doi: 10.1159/000135702. Epub 2008 Jun 3.
Common variable immunodeficiency (CVID) is the most common primary antibody deficiency syndrome in humans, but it remains a diagnosis of exclusion in most cases. Several genetically defined primary immunodeficiencies mimic CVID. Among them is the X-linked lymphoproliferative syndrome (XLP) which was shown to be caused by either mutations in the gene SH2D1a/SAP or, more recently, in the BIRC4/XIAP gene.
We therefore analyzed a cohort of 28 male CVID patients and 2 patients with an IgG subclass deficiency for the prevalence of mutations in BIRC4, encoding for XIAP by direct sequencing.
All patients showed a wild-type sequence of BIRC4/XIAP. Two SNPs, rs5956583 (dbSNP126) located in exon 6 (P-->Q) and rs28382740 (dbSNP126) in the 3' untranslated region were observed at the same frequencies as reported in public databases.
We found no patient with a defect in the coding sequence of BIRC4/XIAP in our cohort of 30 hypogammaglobulinemic patients. We therefore estimate that XLP caused by XIAP deficiency may be a very rare differential diagnosis in male patients with CVID.
常见变异型免疫缺陷(CVID)是人类最常见的原发性抗体缺陷综合征,但在大多数情况下仍需排除其他疾病才能确诊。几种基因明确的原发性免疫缺陷可模仿CVID。其中X连锁淋巴增殖综合征(XLP)已被证明是由SH2D1a/SAP基因或最近发现的BIRC4/XIAP基因突变引起的。
因此,我们通过直接测序分析了一组28例男性CVID患者和2例IgG亚类缺陷患者中编码XIAP的BIRC4基因突变的发生率。
所有患者的BIRC4/XIAP序列均为野生型。在第6外显子(P→Q)中发现的两个单核苷酸多态性(SNP),rs5956583(dbSNP126)和3'非翻译区中的rs28382740(dbSNP126),其出现频率与公共数据库中报告的相同。
在我们的30例低丙种球蛋白血症患者队列中,未发现BIRC4/XIAP编码序列存在缺陷的患者。因此,我们估计XIAP缺陷引起的XLP在男性CVID患者中可能是一种非常罕见的鉴别诊断。