Autosomal-dominant B-cell deficiency with alopecia due to a mutation in NFKB2 that results in nonprocessable p100

• Published in: Blood 2014-11, Vol.124 (19), p.2964-2972
• Main Authors: Lee, Cindy Eunhee, Fulcher, David A., Whittle, Belinda, Chand, Rochna, Fewings, Nicole, Field, Matthew, Andrews, Daniel, Goodnow, Christopher C., Cook, Matthew C.
• Format: Article
• Language: English
• Subjects: Adult; Alopecia - genetics; Alopecia - immunology; Alopecia - pathology; B-Lymphocytes - immunology; B-Lymphocytes - pathology; CD4-Positive T-Lymphocytes - cytology; CD4-Positive T-Lymphocytes - immunology; Dendritic Cells - cytology; Dendritic Cells - immunology; Family Health; Female; Genes, Dominant; HEK293 Cells; Humans; Immunobiology; Immunologic Deficiency Syndromes - genetics; Immunologic Deficiency Syndromes - immunology; Immunologic Deficiency Syndromes - pathology; Molecular Sequence Data; NF-kappa B - immunology; NF-kappa B p52 Subunit - genetics; NF-kappa B p52 Subunit - metabolism; Pedigree; Phosphorylation - immunology; Point Mutation; Sequence Homology, Amino Acid; Severity of Illness Index
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2014-06-578542

Most genetic defects that arrest B-cell development in the bone marrow present early in life with agammaglobulinemia, whereas incomplete antibody deficiency is usually associated with circulating B cells. We report 3 related individuals with a novel form of severe B-cell deficiency associated with partial persistence of serum immunoglobulin arising from a missense mutation in NFKB2. Significantly, this point mutation results in a D865G substitution and causes a failure of p100 phosphorylation that blocks processing to p52. Severe B-cell deficiency affects mature and transitional cells, mimicking the action of rituximab. This phenotype appears to be due to disruption of canonical and noncanonical nuclear factor κB pathways by the mutant p100 molecule. These findings could be informative for therapeutics as well as immunodeficiency. •A novel NFKB2 mutation confers a severe B-cell deficiency, but antibody production is partially preserved.•Unprocessed p100 results in an IκB-like action on the canonical nuclear factor-κB pathway.