title: Diagnosis of X-linked lymphoproliferative disease by analysis of SLAM-associated protein expression.
abstract: X-linked lymphoproliferative disease (XLP) is an inherited immunodeficiency in which affected boys show abnormal responses to Epstein-Barr virus infection. The gene defective in XLP has been identified and designated SH2D1A and encodes a protein termed SLAM-associated protein (SAP). Mutation analysis in individuals with typical XLP presentations and family histories has only detected abnormalities in approximately 60% of patients. Thus, genetic analysis alone cannot confirm a diagnosis of XLP We have developed a SAP expression assay that can be used as a diagnostic indicator of XLP We show that SAP is constitutively expressed in normal individuals, in patients with severe sepsis and in patients with other primary immunodeficiencies. In six XLP patients, four with classical and two with atypical presentations, SAP expression was absent. In the latter two, who were previously assigned as having common variable immunodeficiency (CVID), the diagnosis of XLP was initially made using the protein expression assay. In two further patients in whom no mutation could be detected by genetic analysis, lack of SAP expression strongly suggests that these individuals have XLP. We therefore suggest that XLP should be suspected in certain boys previously diagnosed as having CVID and recommend that patients are investigated both by genetic analysis of SH2D1A and by expression of SAP protein.
authors.affiliation: Department of Immunology, Great Ormond Street Hospital NHS Trust, London, GB.
authors.forename: K C
authors.initials: KC
authors.lastname: Gilmour
authors.forename: T
authors.initials: T
authors.lastname: Cranston
authors.forename: A
authors.initials: A
authors.lastname: Jones
authors.forename: E G
authors.initials: EG
authors.lastname: Davies
authors.forename: D
authors.initials: D
authors.lastname: Goldblatt
authors.forename: A
authors.initials: A
authors.lastname: Thrasher
authors.forename: C
authors.initials: C
authors.lastname: Kinnon
authors.forename: K E
authors.initials: KE
authors.lastname: Nichols
authors.forename: H B
authors.initials: HB
authors.lastname: Gaspar
mesh_terms: D000361:Agammaglobulinemia / Q000378:metabolism; D001483:Base Sequence; D002352:Carrier Proteins / Q000096:biosynthesis* / Q000235:genetics; D019070:Cell Lineage; D002648:Child; D019871:Dyskeratosis Congenita / Q000378:metabolism; D005260:Female; D015870:Gene Expression; D006801:Humans; D047908:Intracellular Signaling Peptides and Proteins; D007963:Leukocytes, Mononuclear / Q000166:cytology; D008232:Lymphoproliferative Disorders / Q000097:blood / Q000175:diagnosis / Q000378:metabolism*; D008297:Male; D008969:Molecular Sequence Data; D016511:Severe Combined Immunodeficiency / Q000378:metabolism; D000071179:Signaling Lymphocytic Activation Molecule Associated Protein; D014923:Wiskott-Aldrich Syndrome / Q000378:metabolism; D014960:X Chromosome
chemical_list: D002352:Carrier Proteins; D047908:Intracellular Signaling Peptides and Proteins; C114953:SH2D1A protein, human; D000071179:Signaling Lymphocytic Activation Molecule Associated Protein