1. Novel Gain-of-Function Mutation in Stat1 Sumoylation Site Leads to CMC/CID Phenotype Responsive to Ruxolitinib
- Author
-
Kimberley Gilmour, T Mohanadas, Andrew J. Cant, AD Rowan, Mary Slatter, S Loughlin, Al, Shehri, T, Shahnaz Bibi, Angela Grainger, Desa Lilic, F Gothe, Timothy Ronan Leahy, and Sophie Hambleton
- Subjects
0301 basic medicine ,Male ,Ruxolitinib ,Primary Immunodeficiency Diseases ,Immunology ,SUMO protein ,medicine.disease_cause ,03 medical and health sciences ,0302 clinical medicine ,Ubiquitin ,Nitriles ,medicine ,Immunology and Allergy ,Humans ,Chronic mucocutaneous candidiasis ,Child ,Immunodeficiency ,Janus kinase inhibitor ,Janus Kinases ,Mutation ,biology ,business.industry ,Candidiasis, Chronic Mucocutaneous ,Sumoylation ,medicine.disease ,030104 developmental biology ,Pyrimidines ,STAT1 Transcription Factor ,Treatment Outcome ,Gain of Function Mutation ,Cancer research ,biology.protein ,Pyrazoles ,Immunocompetence ,business ,030215 immunology ,medicine.drug - Abstract
Mutations in the coiled-coil and DNA-binding domains of STAT1 lead to delayed STAT1 dephosphorylation and subsequently gain-of-function. The associated clinical phenotype is broad and can include chronic mucocutaneous candidiasis (CMC) and/or combined immunodeficiency (CID). We report a case of CMC/CID in a 10-year-old boy due to a novel mutation in the small ubiquitin molecule (SUMO) consensus site at the C-terminal region of STAT1 leading to gain-of-function by impaired sumoylation. Immunodysregulatory features of disease improved after Janus kinase inhibitor (jakinib) treatment. Functional testing after treatment confirmed reversal of the STAT1 hyper-phosphorylation and downstream transcriptional activity. IL-17 and IL-22 production was, however, not restored with jakinib therapy (ruxolitinib), and the patient remained susceptible to opportunistic infection. In conclusion, a mutation in the SUMO consensus site of STAT1 can lead to gain-of-function that is reversible with jakinib treatment. However, full immunocompetence was not restored, suggesting that this treatment strategy might serve well as a bridge to definitive therapy such as hematopoietic stem cell transplant rather than a long-term treatment option.
- Published
- 2019