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Blood, 1 January 2004, Vol. 103, No. 1, pp. 185-187.
Prepublished online as a Blood First Edition Paper on September 4, 2003; DOI 10.1182/blood-2003-06-1964.


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IMMUNOBIOLOGY
Brief report

Female agammaglobulinemia due to the Bruton tyrosine kinase deficiency caused by extremely skewed X-chromosome inactivation

Hidetoshi Takada, Hirokazu Kanegane, Akihiko Nomura, Ken Yamamoto, Kenji Ihara, Yasuhiko Takahashi, Satoshi Tsukada, Toshio Miyawaki, and Toshiro Hara

From the Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Pediatrics, Faculty of Medicine Toyama Medical and Pharmaceutical University, Toyama, Japan; Division of Molecular Population Genetics, Department of Molecular Genetics, Medical Institute of Bioregulation, Kyushu University, Fukuoka, Japan; Departments of Pediatrics, Kyushu Kouseinenkin Hospital, Kitakyushu, Japan; and Department of Molecular Medicine, Osaka University Medical School, Osaka, Japan.

We analyzed the cause of agammaglobulinemia in a girl whose father had been diagnosed as having X-linked agammaglobulinemia (XLA). Flow cytometric analysis revealed the lack of peripheral B cells with the block of B-cell differentiation in the stages between pro-B cells and pre-B cells in the bone marrow, and the defect of the Bruton tyrosine kinase (BTK) expression on monocytes. We found a BTK gene mutation in the first single base pair of intron 11 in her father and heterozygous mutation in the patient at the site. Sequence analysis of abnormally smaller-sized polymerase chain reaction (PCR) products of cDNA confirmed splicing abnormalities due to the mutation. Maternally derived X chromosome was exclusively inactivated in peripheral blood and oral mucosal cells. This is the first report of female XLA caused by heterozygous BTK gene abnormality and extreme nonrandom inactivation of X chromosome on which normal BTK gene is located.


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C. Spatuzza, M. Schiavone, E. Di Salle, E. Janda, M. Sardiello, G. Fiume, O. Fierro, M. Simonetta, N. Argiriou, R. Faraonio, et al.
Physical and functional characterization of the genetic locus of IBtk, an inhibitor of Bruton's tyrosine kinase: evidence for three protein isoforms of IBtk
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