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Blood, 1 June 2005, Vol. 105, No. 11, pp. 4179-4186.
Prepublished online as a Blood First Edition Paper on February 24, 2005; DOI 10.1182/blood-2004-12-4861.
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PLENARY PAPERS
Omenn syndrome due to ARTEMIS mutations
Markus Ege,
Yunmei Ma,
Burkhard Manfras,
Krzysztof Kalwak,
Haihui Lu,
Michael R. Lieber,
Klaus Schwarz, and
Ulrich Pannicke
From the Department of Transfusion Medicine, the University Children's Hospital, and the Division of Infectious Diseases and Clinical Immunology, the Department of Internal Medicine, The University Hospital Ulm, and the Institute for Clinical Transfusion Medicine and Immunogenetics, Ulm, Germany; the Norris Comprehensive Cancer Center, Departments of Pathology, Biochemistry and Molecular Biology, Biological Sciences, and Molecular Microbiology and Immunology, Los Angeles, CA; and the Department of Pediatric Hematology/Oncology and Bone Marrow Transplantation (BMT), The Wroclaw Medical University, Wroclaw, Poland.
Omenn syndrome (OS) is characterized by severe combined immunodeficiency (SCID) associated with erythrodermia, hepatosplenomegaly, lymphadenopathy, and alopecia. In patients with OS, B cells are mostly absent, T-cell counts are normal to elevated, and T cells are frequently activated and express a restricted T-cell receptor (TCR) repertoire. Thus far, inherited hypomorphic mutations of the recombination activating genes 1 and 2 (RAG1/2) have been described in OS. We report on a first patient with clinical and immunologic features of OS caused by hypomorphic ARTEMIS mutations. The patient's T cells expressed / receptors with an oligoclonal repertoire but normal V(D)J recombination coding joints. Sequencing of the ARTEMIS gene revealed a compound heterozygosity in this nonhomologous end-joining (NHEJ) factor, explaining the enhanced radiosensitivity of the patient's primary dermal fibroblasts. The maternal allele contained a null mutation within the active center, whereas the expression of the paternal allele with a start codon (AUG to ACG) mutation partially restored V(D)J recombination and ARTEMIS function in vivo and in vitro.

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