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Saettini F, Fazio G, Moratto D, Galbiati M, Zucchini N, Ippolito D, Dinelli ME, Imberti L, Mauri M, Melzi ML, Bonanomi S, Gerussi A, Pinelli M, Barisani C, Bugarin C, Chiarini M, Giacomelli M, Piazza R, Cazzaniga G, Invernizzi P, Giliani SC, Badolato R, Biondi A. Case Report: Hypomorphic Function and Somatic Reversion in DOCK8 Deficiency in One Patient With Two Novel Variants and Sclerosing Cholangitis. Front Immunol 2021; 12:673487. [PMID: 33936120 PMCID: PMC8085392 DOI: 10.3389/fimmu.2021.673487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/30/2021] [Indexed: 02/05/2023] Open
Abstract
DOCK8 deficiency is a combined immunodeficiency due to biallelic variants in dedicator of cytokinesis 8 (DOCK8) gene. The disease has a wide clinical spectrum encompassing recurrent infections (candidiasis, viral and bacterial infections), virally driven malignancies and immune dysregulatory features, including autoimmune (cytopenia and vasculitis) as well as allergic disorders (eczema, asthma, and food allergy). Hypomorphic function and somatic reversion of DOCK8 has been reported to result in incomplete phenotype without IgE overproduction. Here we describe a case of DOCK8 deficiency in a 8-year-old Caucasian girl. The patient's disease was initially classified as autoimmune thrombocytopenia, which then evolved toward a combined immunodeficiency phenotype with recurrent infections, persistent EBV infection and lymphoproliferation. Two novel variants (one deletion and one premature stop codon) were characterized, resulting in markedly reduced, but not absent, DOCK8 expression. Somatic reversion of the DOCK8 deletion was identified in T cells. Hypomorphic function and somatic reversion were associated with restricted T cell repertoire, decreased STAT5 phosphorylation and impaired immune synapse functioning in T cells. Although the patient presented with incomplete phenotype (absence of markedly increase IgE and eosinophil count), sclerosing cholangitis was incidentally detected, thus indicating that hypomorphic function and somatic reversion of DOCK8 may delay disease progression but do not necessarily prevent from severe complications.
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Affiliation(s)
- Francesco Saettini
- Pediatric Hematology Outpatient Clinic, Department of Pediatrics, Fondazione MBBM, Monza, Italy
- *Correspondence: Francesco Saettini,
| | - Grazia Fazio
- Centro Ricerca Tettamanti, University of Milano Bicocca, Monza, Italy
| | - Daniele Moratto
- Flow Cytometry Laboratory, Diagnostic Department, ASST Spedali Civili, Brescia, Italy
| | - Marta Galbiati
- Centro Ricerca Tettamanti, University of Milano Bicocca, Monza, Italy
| | - Nicola Zucchini
- Division of Pathology, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Davide Ippolito
- Department of Diagnostic Radiology, San Gerardo Hospital, Monza, Italy
| | | | - Luisa Imberti
- Centro di Ricerca Emato-oncologica AIL (CREA), ASST Spedali Civili, Brescia, Italy
| | - Mario Mauri
- Department of Medicine and Surgery, University of Milano Bicocca and San Gerardo Hospital, Monza, Italy
| | | | - Sonia Bonanomi
- Pediatric Hematology Outpatient Clinic, Department of Pediatrics, Fondazione MBBM, Monza, Italy
| | - Alessio Gerussi
- Division of Gastroenterology, Centre for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Marinella Pinelli
- Cytogenetic and Medical Genetic Unit, Department of Molecular and Translational medicine, A. Nocivelli Institute for Molecular Medicine, University of Brescia, Spedali Civili, Brescia, Italy
| | - Chiara Barisani
- Cytogenetic and Medical Genetic Unit, Department of Molecular and Translational medicine, A. Nocivelli Institute for Molecular Medicine, University of Brescia, Spedali Civili, Brescia, Italy
| | - Cristina Bugarin
- Centro Ricerca Tettamanti, University of Milano Bicocca, Monza, Italy
| | - Marco Chiarini
- Flow Cytometry Laboratory, Diagnostic Department, ASST Spedali Civili, Brescia, Italy
| | - Mauro Giacomelli
- Cytogenetic and Medical Genetic Unit, Department of Molecular and Translational medicine, A. Nocivelli Institute for Molecular Medicine, University of Brescia, Spedali Civili, Brescia, Italy
| | - Rocco Piazza
- Department of Medicine and Surgery, University of Milano Bicocca and San Gerardo Hospital, Monza, Italy
| | - Giovanni Cazzaniga
- Centro Ricerca Tettamanti, University of Milano Bicocca, Monza, Italy
- Department of Medicine and Surgery, University of Milano Bicocca and San Gerardo Hospital, Monza, Italy
| | - Pietro Invernizzi
- Division of Gastroenterology, Centre for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Silvia Clara Giliani
- Cytogenetic and Medical Genetic Unit, Department of Molecular and Translational medicine, A. Nocivelli Institute for Molecular Medicine, University of Brescia, Spedali Civili, Brescia, Italy
| | - Raffaele Badolato
- Department of Clinical and Experimental Sciences, Pediatrics Clinic and A. Nocivelli Institute for Molecular Medicine A, University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - Andrea Biondi
- Pediatric Hematology Outpatient Clinic, Department of Pediatrics, Fondazione MBBM, Monza, Italy
- Centro Ricerca Tettamanti, University of Milano Bicocca, Monza, Italy
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