title: A nonsense mutation in IKBKB causes combined immunodeficiency.
abstract: Identification of the molecular etiologies of primary immunodeficiencies has led to important insights into the development and function of the immune system. We report here the cause of combined immunodeficiency in 4 patients from 2 different consanguineous Qatari families with similar clinical and immunologic phenotypes. The patients presented at an early age with fungal, viral, and bacterial infections and hypogammaglobulinemia. Although their B- and T-cell numbers were normal, they had low regulatory T-cell and NK-cell numbers. Moreover, patients' T cells were mostly CD45RA(+)-naive cells and were defective in activation after T-cell receptor stimulation. All patients contained the same homozygous nonsense mutation in IKBKB (R286X), revealed by whole-exome sequencing with undetectable IKKβ and severely decreased NEMO proteins. Mutant IKKβ(R286X) was unable to complex with IKKα/NEMO. Immortalized patient B cells displayed impaired IκBα phosphorylation and NFκB nuclear translocation. These data indicate that mutated IKBKB is the likely cause of immunodeficiency in these 4 patients.
authors.affiliation: Department of Internal Medicine, Section of Pulmonary, Critical Care, Allergy and Immunological Diseases, Wake Forest University School of Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC; Department of Pediatrics, Division of Allergy and Immunology.
authors.forename: Talal
authors.initials: T
authors.lastname: Mousallem
authors.affiliation: Department of Pediatrics, Division of Allergy and Immunology.
authors.forename: Jialong
authors.initials: J
authors.lastname: Yang
authors.affiliation: Center for Human Genome Variation, and.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Urban
authors.affiliation: Department of Pediatrics, Division of Allergy and Immunology, Department of Immunology, Duke University Medical Center, Durham, NC;
authors.forename: Hongxia
authors.initials: H
authors.lastname: Wang
authors.affiliation: Hamad Medical Corporation, Doha, Qatar; and.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Adeli
authors.affiliation: Department of Pediatrics, Division of Allergy and Immunology.
authors.forename: Roberta E
authors.initials: RE
authors.lastname: Parrott
authors.affiliation: Department of Pediatrics, Division of Allergy and Immunology.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Roberts
authors.affiliation: Center for Human Genome Variation, and.
authors.forename: David B
authors.initials: DB
authors.lastname: Goldstein
authors.affiliation: Department of Pediatrics, Division of Allergy and Immunology, Department of Immunology, Duke University Medical Center, Durham, NC;
authors.forename: Rebecca H
authors.identifier: http://orcid.org/0000-0002-6914-346X
authors.initials: RH
authors.lastname: Buckley
authors.affiliation: Department of Pediatrics, Division of Allergy and Immunology, Department of Immunology, Duke University Medical Center, Durham, NC;
authors.forename: Xiao-Ping
authors.initials: XP
authors.lastname: Zhong
mesh_terms: D018389:Codon, Nonsense; D005190:Family; D005260:Female; D006720:Homozygote; D006801:Humans; D051550:I-kappa B Kinase / Q000235:genetics*; D007223:Infant; D008297:Male; D016511:Severe Combined Immunodeficiency / Q000175:diagnosis / Q000235:genetics* / Q000276:immunology* / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D018389:Codon, Nonsense; D051550:I-kappa B Kinase