A gain-of-function RAC2 mutation is associated with bone-marrow hypoplasia and an autosomal dominant form of severe combined immunodeficiency

Haematologica. 2021 Feb 1;106(2):404-411. doi: 10.3324/haematol.2019.230250.

Abstract

Severe combined immunodeficiencies (SCIDs) constitute a heterogeneous group of life-threatening genetic disorders that typically present in the first year of life. They are defined by the absence of autologous T cells and the presence of an intrinsic or extrinsic defect in the B-cell compartment. In three newborns presenting with frequent infections and profound leukopenia, we identified a private, heterozygous mutation in the RAC2 gene (p.G12R). This mutation was de novo in the index case, who had been cured by hematopoietic stem cell transplantation but had transmitted the mutation to her sick daughter. Biochemical assays showed that the mutation was associated with a gain of function. The results of in vitro differentiation assays showed that RAC2 is essential for the survival and differentiation of hematopoietic stem/progenitor cells. Therefore, screening for RAC2 gain-of-function mutations should be considered in patients with a SCID phenotype and who lack a molecular diagnosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bone Marrow
  • Bone Marrow Failure Disorders
  • Female
  • Gain of Function Mutation
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Infant, Newborn
  • Mutation
  • RAC2 GTP-Binding Protein
  • Severe Combined Immunodeficiency* / diagnosis
  • Severe Combined Immunodeficiency* / genetics
  • Severe Combined Immunodeficiency* / therapy
  • rac GTP-Binding Proteins*

Substances

  • rac GTP-Binding Proteins

Grants and funding

FundingThis study was funded by the French National Institute of Health and Medical Research (INSERM). The work at the CRCT was funded by an “Equipe Labellisée par la Fondation pour la Recherche Médicale” grant.