Yan S, Wei Y S, Yang Q Y, Yang L, Zeng T, Tang X M, Zhao X D, An Y F
Department of Rheumatology and Immunology, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing 400014, China.
Zhonghua Er Ke Za Zhi. 2020 Mar 2;58(3):223-227. doi: 10.3760/cma.j.issn.0578-1310.2020.03.012.
To analyze the clinical , immunological and genetic features of a child with BCL11B mutation induced neurodevelopmental disorder. The clinical data and genetic test of a child with BCL11B mutation hospitalized in the Department of Rheumatology and Immunology in Children's Hospital of Chongqing Medical University in December 2018 were extracted and analyzed. The literature was searched with "BCL11B mutation" and "immunodeficiency 49" as key words in Chinese databases and Pubmed until January 2019 was reviewed. A male patient aged 3 years and 11 months with facial dysmorphisms and delayed language and motor development was admitted due to neurodevelopmental retardation over two years. Laboratory tests showed normal human immunoglobulin (IgG 12.90 g/L, IgA 1.02 g/L, IgM 1.15 g/L, IgE 532 000 U/L), Trec (228) and proliferation of T and B cells. The lymphocyte subsets revealeda reduced percentage of B cells (0.108) but normal absolute numbers (0.574×10(-3)/L), and an increased percentage (0.828) as well as absolute numbers (4.415×10(-3)/L) of T cells. A heterozygous BCL11B mutation was detected by sanger sequencing, showing a de novo frameshift mutation c.1887_c.1893delCGGCGGG in exon 4. Two papers were found which were all in English, with total of 14 patients(13 patients with complete information). Thirteen mutations were reposed, including 7 frameshift, 2 nonsense, 2 missense, and 2 chromosomal rearrangements; Thirteen patients had heterozygous mutations. All patients had delayed language and motor development and facial dysplasia which were mainly hypertelorism, thin eyebrows and small palpebral fissures. Some patients had dental anomalies, ametropia and allergy, and a few were combined with immune impairment, but without overt signs of immunodeficiency. Only one patient had multisystem anomalies and profound immune deficiency. BCL11B is essential for development of the nervous and the immune system. In this study, the de novo mutation of BCL11B gene resulted in neurodevelopmental and immunological disorders.
分析1例由BCL11B突变引起的神经发育障碍患儿的临床、免疫学及遗传学特征。提取并分析2018年12月在重庆医科大学附属儿童医院风湿免疫科住院的1例BCL11B突变患儿的临床资料及基因检测结果。以“BCL11B突变”和“免疫缺陷49”为关键词,在中国数据库及Pubmed中检索文献,直至2019年1月并进行综述。1例3岁11个月男性患儿因两年多来的神经发育迟缓入院,伴有面部畸形及语言和运动发育迟缓。实验室检查显示人类免疫球蛋白正常(IgG 12.90 g/L,IgA 1.02 g/L,IgM 1.15 g/L,IgE 532 000 U/L)、Trec(228)以及T和B细胞增殖。淋巴细胞亚群显示B细胞百分比降低(0.108)但绝对计数正常(0.574×10⁻³/L),T细胞百分比(0.828)及绝对计数(4.415×10⁻³/L)均升高。通过桑格测序检测到杂合性BCL11B突变,显示外显子4中存在新发移码突变c.1887_c.1893delCGGCGGG。共发现2篇英文文献,总计14例患者(13例信息完整)。报告了13种突变,包括7种移码突变、2种无义突变、2种错义突变和2种染色体重排;13例患者为杂合突变。所有患者均有语言和运动发育迟缓及面部发育异常,主要为眼距增宽、眉毛稀疏和睑裂小。部分患者有牙齿异常、屈光不正和过敏,少数合并免疫损害,但无明显免疫缺陷体征。仅1例患者有多系统异常及严重免疫缺陷。BCL11B对神经和免疫系统的发育至关重要。在本研究中,BCL11B基因的新发突变导致了神经发育和免疫紊乱。