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Blood, 1 May 2001, Vol. 97, No. 9, pp. 2561-2567
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Neutrophil-specific granule deficiency: homozygous recessive
inheritance of a frameshift mutation in the gene encoding transcription
factor CCAAT/enhancer binding protein-
Adrian F. Gombart,
Masaaki Shiohara,
Scott H. Kwok,
Kazunaga Agematsu,
Atsushi Komiyama, and
H. Phillip Koeffler
From Cedars-Sinai Medical Center, Burns and Allen
Research Institute, Division of Hematology/Oncology, UCLA School of
Medicine, Los Angeles, CA, and Department of Pediatrics, Shinshu
University School of Medicine, Matsumoto, Japan.
Neutrophil-specific granule deficiency (SGD) is a rare congenital
disorder. The neutrophils of individuals with SGD display atypical
bi-lobed nuclei, lack expression of all secondary and tertiary granule
proteins, and possess defects in chemotaxis, disaggregation, receptor
up-regulation, and bactericidal activity, resulting in frequent and
severe bacterial infections. Previously, a homozygous mutation in the
CCAAT/enhancer binding protein- (C/EBP ) gene was reported for one case of SGD. To
substantiate the role of C/EBP in the development of SGD and
elucidate its mechanism of inheritance, the mutational status of the
gene was determined in a second individual. An A-nucleotide
insertion in the coding region of the C/EBP gene was
detected. This mutation completely abolished the predicted translation
of all C/EBP isoforms. Microsatellite and nucleotide sequence
analyses of the C/EBP locus in the parents of the
proband indicated that the disorder may have resulted from homozygous
recessive inheritance of the mutant allele from an ancestor shared by
both parents. The mutant C/EBP 32 protein localized in
the cytoplasm rather than the nucleus and was unable to activate
transcription. Consistent with this, a significant decrease in the
levels of the messenger RNAs (mRNAs) encoding the secondary granule
protein human 18-kd cationic antimicrobial protein
(hCAP-18)/LL-37 and the primary granule protein
bactericidal/permeability-increasing protein were observed in the
patient. The hCAP-18 mRNA was induced by overexpression of
C/EBP 32 in the human myeloid leukemia cell line, U937,
supporting the hypothesis that C/EBP is a key regulator of
granule gene synthesis. This study strongly implicates mutation of the
C/EBP gene as the primary genetic defect involved in the development of neutrophil SGD and defines its mechanism of inheritance.

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