title: Female hyper IgM syndrome type 1 with a chromosomal translocation disrupting CD40LG.
abstract: Hyper-IgM syndrome type 1 (HIGM1) is a primary immunodeficiency characterized by recurrent bacterial and opportunistic infections, associated with normal or high serum level of IgM and decreased serum levels of IgG, IgA and IgE due to the defect of class switch recombination. CD40LG, located in Xq26, has been reported to be mutated in male HIGM1 patients. Here, we report the second case of a female HIGM1 with the defect of CD40 ligand (CD40L) expression and of soluble serum CD40L. Clinical course and HIGM phenotype was indistinguishable from that of male HIGM1 including severe neutropenia. High-resolution chromosome banding revealed that this patient's karyotype is 46, X, t(X;14)(q26.3;q13.1), and FISH analysis demonstrated that the break point of the chromosomal translocation is within CD40LG. Using four chimeric cDNA clones obtained by 3' RACE method, the break point was identified within the intron 4 of CD40LG on X chromosome and non-coding region of chromosome 14. We also found an extremely skewed X-chromosome inactivation pattern by methylation-specific PCR. Thus, the reciprocal translocation caused the disruption of CD40LG, resulting in defective CD40L expression in the female patient with an extremely skewed X-inactivation pattern in T cells leading to the HIGM1 phenotype.
authors.affiliation: Department of Pediatrics, National Defense Medical College, 359-8513, 3-2, Namiki, Tokorozawa, Saitama, Japan.
authors.forename: Kohsuke
authors.initials: K
authors.lastname: Imai
authors.forename: Mitsunobu
authors.initials: M
authors.lastname: Shimadzu
authors.forename: Takeo
authors.initials: T
authors.lastname: Kubota
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Morio
authors.forename: Takeshi
authors.initials: T
authors.lastname: Matsunaga
authors.forename: Young-Dong
authors.initials: YD
authors.lastname: Park
authors.forename: Akira
authors.initials: A
authors.lastname: Yoshioka
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Nonoyama
mesh_terms: D000911:Antibodies, Monoclonal / Q000276:immunology; D023201:CD40 Ligand / Q000097:blood / Q000235:genetics; D002883:Chromosomes, Human, Pair 14; D041321:Chromosomes, Human, X; D005260:Female; D006801:Humans; D006942:Hypergammaglobulinemia / Q000235:genetics*; D017578:Immunoglobulin Class Switching; D007075:Immunoglobulin M / Q000097:blood*; D017404:In Situ Hybridization, Fluorescence; D015847:Interleukin-4 / Q000276:immunology; D008297:Male; D013577:Syndrome; D013601:T-Lymphocytes / Q000276:immunology; D014178:Translocation, Genetic; D049951:X Chromosome Inactivation
chemical_list: D000911:Antibodies, Monoclonal; D007075:Immunoglobulin M; D023201:CD40 Ligand; D015847:Interleukin-4