title: Mutations in the gene encoding neutrophil elastase in congenital and cyclic neutropenia.
abstract: Congenital neutropenia and cyclic neutropenia are disorders of neutrophil production predisposing patients to recurrent bacterial infections. Recently the locus for autosomal dominant cyclic neutropenia was mapped to chromosome 19p13.3, and this disease is now attributable to mutations of the gene encoding neutrophil elastase (the ELA2 gene). The authors hypothesized that congenital neutropenia is also due to mutations of neutrophil elastase. Patients with congenital neutropenia, cyclic neutropenia, or Shwachman-Diamond syndrome were referred to the Severe Chronic Neutropenia International Registry. Referring physicians provided hematologic and clinical data. Mutational analysis was performed by sequencing polymerase chain reaction (PCR)-amplified genomic DNA for each of the 5 exons of the neutrophil ELA2 gene and 20 bases of the flanking regions. RNA from bone marrow mononuclear cells was used to determine if the affected patients expressed both the normal and the abnormal transcript. Twenty-two of 25 patients with congenital neutropenia had 18 different heterozygous mutations. Four of 4 patients with cyclic neutropenia and 0 of 3 patients with Shwachman-Diamond syndrome had mutations. For 5 patients with congenital neutropenia having mutations predicted to alter RNA splicing or transcript structure, reverse transcriptase-PCR showed expression of both normal and abnormal transcripts. In cyclic neutropenia, the mutations appeared to cluster near the active site of the molecule, whereas the opposite face was predominantly affected by the mutations found in congenital neutropenia. This study indicates that mutations of the gene encoding neutrophil elastase are probably the most common cause for severe congenital neutropenia as well as the cause for sporadic and autosomal dominant cyclic neutropenia.
authors.affiliation: Divisions of Hematology and Medical Genetics, Department of Medicine and the Markey Molecular Medicine Center, University of Washington School of Medicine, Seattle, WA, USA. dcdale@u.washington.edu
authors.forename: D C
authors.initials: DC
authors.lastname: Dale
authors.forename: R E
authors.initials: RE
authors.lastname: Person
authors.forename: A A
authors.initials: AA
authors.lastname: Bolyard
authors.forename: A G
authors.initials: AG
authors.lastname: Aprikyan
authors.forename: C
authors.initials: C
authors.lastname: Bos
authors.forename: M A
authors.initials: MA
authors.lastname: Bonilla
authors.forename: L A
authors.initials: LA
authors.lastname: Boxer
authors.forename: G
authors.initials: G
authors.lastname: Kannourakis
authors.forename: C
authors.initials: C
authors.lastname: Zeidler
authors.forename: K
authors.initials: K
authors.lastname: Welte
authors.forename: K F
authors.initials: KF
authors.lastname: Benson
authors.forename: M
authors.initials: M
authors.lastname: Horwitz
mesh_terms: D000293:Adolescent; D000328:Adult; D001665:Binding Sites; D001854:Bone Marrow Cells / Q000737:chemistry; D002648:Child; D002675:Child, Preschool; D002874:Chromosome Mapping; D002888:Chromosomes, Human, Pair 19; D005260:Female; D006801:Humans; D007223:Infant; D019272:Leukocyte Elastase / Q000737:chemistry / Q000235:genetics*; D008297:Male; D008875:Middle Aged; D008958:Models, Molecular; D015394:Molecular Structure; D009154:Mutation; D009503:Neutropenia / Q000151:congenital* / Q000201:enzymology* / Q000235:genetics; D012313:RNA / Q000032:analysis; D012326:RNA Splicing; D012333:RNA, Messenger / Q000737:chemistry; D020133:Reverse Transcriptase Polymerase Chain Reaction
chemical_list: D012333:RNA, Messenger; D012313:RNA; D019272:Leukocyte Elastase