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常染色体隐性完全 STAT1 缺陷症由复合杂合内含子突变引起。

Autosomal recessive complete STAT1 deficiency caused by compound heterozygous intronic mutations.

机构信息

Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.

Department of Pediatrics, Seirei Hamamatsu General Hospital, Shizuoka, Japan.

出版信息

Int Immunol. 2020 Sep 30;32(10):663-671. doi: 10.1093/intimm/dxaa043.

Abstract

Autosomal recessive (AR) complete signal transducer and activator of transcription 1 (STAT1) deficiency is an extremely rare primary immunodeficiency that causes life-threatening mycobacterial and viral infections. Only seven patients from five unrelated families with this disorder have been so far reported. All causal STAT1 mutations reported are exonic and homozygous. We studied a patient with susceptibility to mycobacteria and virus infections, resulting in identification of AR complete STAT1 deficiency due to compound heterozygous mutations, both located in introns: c.128+2 T>G and c.542-8 A>G. Both mutations were the first intronic STAT1 mutations to cause AR complete STAT1 deficiency. Targeted RNA-seq documented the impairment of STAT1 mRNA expression and contributed to the identification of the intronic mutations. The patient's cells showed a lack of STAT1 expression and phosphorylation, and severe impairment of the cellular response to IFN-γ and IFN-α. The case reflects the importance of accurate clinical diagnosis and precise evaluation, to include intronic mutations, in the comprehensive genomic study when the patient lacks molecular pathogenesis. In conclusion, AR complete STAT1 deficiency can be caused by compound heterozygous and intronic mutations. Targeted RNA-seq-based systemic gene expression assay may help to increase diagnostic yield in inconclusive cases after comprehensive genomic study.

摘要

常染色体隐性(AR)完全信号转导子和转录激活子 1(STAT1)缺陷是一种极其罕见的原发性免疫缺陷病,可导致危及生命的分枝杆菌和病毒感染。到目前为止,仅报道了来自五个无关家庭的七名患有这种疾病的患者。所有报道的致病 STAT1 突变均为外显子纯合子。我们研究了一名易受分枝杆菌和病毒感染的患者,结果由于复合杂合突变(均位于内含子中)导致 AR 完全 STAT1 缺陷:c.128+2 T>G 和 c.542-8 A>G。这两种突变均为第一个导致 AR 完全 STAT1 缺陷的 STAT1 内含子突变。靶向 RNA-seq 记录了 STAT1 mRNA 表达的损伤,有助于鉴定内含子突变。患者的细胞表现出 STAT1 表达和磷酸化的缺乏,以及对 IFN-γ 和 IFN-α 的细胞反应严重受损。该病例反映了在患者缺乏分子发病机制的情况下,准确的临床诊断和精确评估的重要性,包括内含子突变,在全面的基因组研究中。总之,AR 完全 STAT1 缺陷可由复合杂合和内含子突变引起。基于靶向 RNA-seq 的系统基因表达分析可能有助于在全面基因组研究后,在结论不确定的情况下提高诊断率。

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