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Blood, 15 September 2007, Vol. 110, No. 6, pp. 1906-1915.
Prepublished online as a Blood First Edition Paper on May 24, 2007; DOI 10.1182/blood-2007-02-074468.


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IMMUNOBIOLOGY

Defective cytotoxic lymphocyte degranulation in syntaxin-11–deficient familial hemophagocytic lymphohistiocytosis 4 (FHL4) patients

Yenan T. Bryceson1,2, Eva Rudd3,4, Chengyun Zheng3,4, Josefine Edner3,4, Daoxin Ma3,4, Stephanie M. Wood1,5, Anne Grete Bechensteen6, Jaap J. Boelens7, Tiraje Celkan8, Roula A. Farah9, Kjell Hultenby10, Jacek Winiarski11, Paul A. Roche12, Magnus Nordenskjöld4, Jan-Inge Henter3, Eric O. Long2, and Hans-Gustaf Ljunggren1

1 Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden; 2 Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD; 3 Childhood Cancer Research Unit, Department of Woman and Child Health, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden; 4 Clinical Genetics Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden; 5 Institute for Molecular Bioscience, University of Queensland, Brisbane, Australia; 6 Department of Pediatrics, Ullevål University Hospital, Oslo, Norway; 7 Department of Immunology/Hematology and Bone Marrow Transplantation (BMT), University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, the Netherlands; 8 Department of Pediatric Hematology-Oncology, Istanbul University, Cerrahpasa Faculty of Medicine, Istanbul, Turkey; 9 Department of Pediatrics, St Georges Hospital, Balamand University, Beirut, Lebanon; 10 Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden; 11 Pediatrics Unit, Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden; 12 Experimental Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD

Familial hemophagocytic lymphohistiocytosis (FHL) is typically an early onset, fatal disease characterized by a sepsislike illness with cytopenia, hepatosplenomegaly, and deficient lymphocyte cytotoxicity. Disease-causing mutations have been identified in genes encoding perforin (PRF1/FHL2), Munc13-4 (UNC13D/FHL3), and syntaxin-11 (STX11/FHL4). In contrast to mutations leading to loss of perforin and Munc13-4 function, it is unclear how syntaxin-11 loss-of-function mutations contribute to disease. We show here that freshly isolated, resting natural killer (NK) cells and CD8+ T cells express syntaxin-11. In infants, NK cells are the predominant perforin-containing cell type. NK cells from FHL4 patients fail to degranulate when encountering susceptible target cells. Unexpectedly, IL-2 stimulation partially restores degranulation and cytotoxicity by NK cells, which could explain the less severe disease progression observed in FHL4 patients, compared with FHL2 and FHL3 patients. Since the effector T-cell compartment is still immature in infants, our data suggest that the observed defect in NK-cell degranulation may contribute to the pathophysiology of FHL, that evaluation of NK-cell degranulation in suspected FHL patients may facilitate diagnosis, and that these new insights may offer novel therapeutic possibilities.


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