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Blood, 15 March 2005, Vol. 105, No. 6, pp. 2449-2457. Prepublished online as a Blood First Edition Paper on November 9, 2004; DOI 10.1182/blood-2004-06-2289.
IMMUNOBIOLOGY WHIM syndromes with different genetic anomalies are accounted for by impaired CXCR4 desensitization to CXCL12From the Unité d'Immunologie Virale, Institut Pasteur, Paris, France; the Unité de Chimie Organique, Institut Pasteur, Paris, France; the Servicio de Reumatología, Unidad de Investigación, Hospital 12 de Octubre, Madrid, Spain; the Service d'Anatomie Pathologique, Hôpital Saint-Louis, Paris, France; the Service de Dermatologie, Hôpital Saint-Louis, Paris, France; the Centre National de la Recherche Scientifique Unite Mixte de Recherche 8147, Hôpital Necker, Paris, France; the Institut National de la Santé et de la Recherche Médicale (INSERM) U503, Universite Claude Bernard et Hospices Civils de Lyon, Lyon, France; the Service d'Hématologie Biologique, Centre Hospitalo-Universitaire de Nancy, Vandoeuvre-Les-Nancy, France; the Service de Thérapie Cellulaire et Tissulaire, Centre Hospitalo-Universitaire de Nancy, Vandoeuvre-Les-Nancy, France; the Unité de Transplantation Médullaire, Centre Hospitalo-Universitaire de Nancy, Vandoeuvre-Les-Nancy, France; and the Laboratoire d'Immunologie Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France.
The WHIM syndrome is a rare immunodeficiency disorder characterized by warts, hypogammaglobulinemia, infections, and myelokathexis. Dominant heterozygous mutations of the gene encoding CXCR4, a G-proteincoupled receptor with a unique ligand, CXCL12, have been associated with this pathology. We studied patients belonging to 3 different pedigrees. Two siblings inherited a CXCR4 mutation encoding a novel C-terminally truncated receptor. Two unrelated patients were found to bear a wild-type CXCR4 open reading frame. Circulating lymphocytes and neutrophils from all patients displayed similar functional alterations of CXCR4-mediated responses featured by a marked enhancement of G-proteindependent responses. This phenomenon relies on the refractoriness of CXCR4 to be both desensitized and internalized in response to CXCL12. Therefore, the aberrant dysfunction of the CXCR4-mediated signaling constitutes a common biologic trait of WHIM syndromes with different causative genetic anomalies. Responses to other chemokines, namely CCL4, CCL5, and CCL21, were preserved, suggesting that, in clinical forms associated with a wild-type CXCR4 open reading frame, the genetic anomaly might target an effector with some degree of selectivity for the CXCL12/CXCR4 axis. We propose that the sustained CXCR4 activity in patient cells accounts for the immune-hematologic clinical manifestations and the profusion of warts characteristic of the WHIM syndrome.
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