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Blood, 15 October 2005, Vol. 106, No. 8, pp. 2815-2817.
Prepublished online as a Blood First Edition Paper on June 28, 2005; DOI 10.1182/blood-2004-12-4724.


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IMMUNOBIOLOGY

Mosaicism of NK cells in a patient with Wiskott-Aldrich syndrome

Maxim I. Lutskiy, Diana S. Beardsley, Fred S. Rosen, and Eileen Remold-O'Donnell

From the CBR Institute for Biomedical Research and the Department of Pediatrics, Harvard Medical School, Boston, MA; and the Department of Pediatrics, Yale University School of Medicine, New Haven, CT.

Rare cases of somatic mosaicism resulting from reversion of inherited mutations can lead to the attenuation of blood-cell disorders, including Wiskott-Aldrich syndrome (WAS). The impact of the revertant hematopoietic stem or progenitor cells, particularly their representation in blood-cell populations, is of interest because it predicts the outcome of gene therapy. Here we report an 8-year-old patient with WAS caused by a single nucleotide insertion in the WASP gene that abrogates protein expression. The patient nonetheless had mild disease. We found reversion of the mutation in a fraction of patient lymphocytes. Forty percent of natural killer (NK) cells expressed Wiskott-Aldrich syndrome protein (WASP), and NK cells contained both mutated and revertant (normal) sequences. WASP was not expressed in patient T or B cells; T cells contained only the mutated sequence. The selective advantage of WASP+ NK cells was also demonstrated for carrier females. The enrichment of WASP+-revertant NK cells indicates that WASP provides a selective advantage in this lineage and predicts the success of gene therapy for reconstituting the NK-cell compartment. The importance of reconstituting the NK-cell lineage is discussed. (Blood. 2005;106:2815-2817)


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