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Somatic Reversion of Pathogenic Dock8 Variants Alters Lymphocyte Differentiation and Function to Effectively Cure Dock8 Deficiency Publisher Pubmed



Pillay BA1, 2 ; Fusaro M3, 4, 5 ; Gray PE6, 7, 8 ; Statham AL1 ; Burnett L1, 2, 8 ; Bezrodnik L9 ; Kane A1, 2, 8, 10, 11, 12 ; Tong W8, 11 ; Abdo C13 ; Winter S3, 5, 14 ; Chevalier S4 ; Levy R3, 14, 15 ; Masson C3, 16 ; Schmitt Y3, 17, 18 Show All Authors
Authors
  1. Pillay BA1, 2
  2. Fusaro M3, 4, 5
  3. Gray PE6, 7, 8
  4. Statham AL1
  5. Burnett L1, 2, 8
  6. Bezrodnik L9
  7. Kane A1, 2, 8, 10, 11, 12
  8. Tong W8, 11
  9. Abdo C13
  10. Winter S3, 5, 14
  11. Chevalier S4
  12. Levy R3, 14, 15
  13. Masson C3, 16
  14. Schmitt Y3, 17, 18
  15. Bole C17
  16. Malphettes M19
  17. Macintyre E13
  18. De Villartay JP20
  19. Ziegler JB6, 7, 8
  20. Smart JM21
  21. Peake J22
  22. Aghamohammadi A23
  23. Hammarstrom L24
  24. Abolhassani H23, 24
  25. Picard C3, 4, 5, 14
  26. Fischer A3, 14, 25, 26
  27. Latour S5
  28. Neven B14, 27
  29. Tangye SG1, 2, 8
  30. Ma CS1, 2, 8

Source: Journal of Clinical Investigation Published:2021


Abstract

Inborn errors of immunity cause monogenic immune dysregulatory conditions such as severe and recurrent pathogen infection, inflammation, allergy, and malignancy. Somatic reversion refers to the spontaneous repair of a pathogenic germline genetic variant and has been reported to occur in a number of inborn errors of immunity, with a range of impacts on clinical outcomes of these conditions. DOCK8 deficiency due to biallelic inactivating mutations in DOCK8 causes a combined immunodeficiency characterized by severe bacterial, viral, and fungal infections, as well as allergic disease and some cancers. Here, we describe the clinical, genetic, and cellular features of 3 patients with biallelic DOCK8 variants who, following somatic reversion in multiple lymphocyte subsets, exhibited improved clinical features, including complete resolution of infection and allergic disease, and cure over time. Acquisition of DOCK8 expression restored defective lymphocyte signalling, survival and proliferation, as well as CD8+ T cell cytotoxicity, CD4+ T cell cytokine production, and memory B cell generation compared with typical DOCK8-deficient patients. Our temporal analysis of DOCK8-revertant and DOCK8-deficient cells within the same individual established mechanisms of clinical improvement in these patients following somatic reversion and revealed further nonredundant functions of DOCK8 in human lymphocyte biology. Last, our findings have significant implications for future therapeutic options for the treatment of DOCK8 deficiency. Copyright: © 2021, American Society for Clinical Investigation.
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