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Blood, 15 August 2006, Vol. 108, No. 4, pp. 1306-1312.
Prepublished online as a Blood First Edition Paper on April 20, 2006; DOI 10.1182/blood-2006-04-015776.
Previous Article | Next Article 
Submitted April 7, 2006
Accepted April 7, 2006
A homozygous Fas ligand gene mutation in a patient causes a new type of autoimmune lymphoproliferative syndrome
Manuel Del-Rey, Jesus Ruiz-Contreras, Alberto Bosque, Sara Calleja, Jose Gomez-Rial, Ernesto Roldan, Pablo Morales, Antonio Serrano, Alberto Anel, Estela Paz-Artal, and Luis M Allende*
Servicio de Inmunologia, Hospital Universitario 12 de Octubre, Madrid, Spain
Unidad de Inmunodeficiencias. Hospital Universitario 12 de Octubre, Madrid, Spain
Dpto. Bioquimica, Biologia Molecular y Celular, Universidad de Zaragoza
Servicio de Inmunologia, Hospital Ramon y Cajal, Madrid, Spain
* Corresponding author; email: lallende.hdoc{at}salud.madrid.org.
Autoimmune lymphoproliferative syndrome (ALPS) is a
disorder characterized by lymphoproliferation and
autoimmune clinical manifestations and is generally
caused by a defective Fas-mediated apoptosis. This
report describes the first homozygous FasL gene mutation
in a woman with clinical and immunological features of
ALPS. T-cell blasts from the patient did not induce FasL-
mediated apoptosis on Fas-transfected murine L1210 or on
Jurkat cells and activation-induced cell death was
impaired. Furthermore, Fas-dependent cytotoxicity was
drastically reduced in COS cells transfected with the
mutant FasL. In addition, FasL expression on T-cell
blasts from the patient was similar to that observed in
a healthy control, despite bearing the high-producer
genotype
- 844C/C in her FasL promoter. Sequencing of the
patient's FasL gene revealed a new mutation in exon 4
(A247E). The location of A247E in the FasL extracellular
domain and the conservation of the protein sequence of
that region recorded in eight different species from
human support the essential role of FasL COOH terminal
domain in Fas/FasL binding. These findings provide
evidence that inherited nonlethal FasL abnormalities
causes an uncommon apoptosis defect producing
lymphoproliferative disease and highlight the need for a
review of the current ALPS classification to include a
new ALPS type Ic subgroup.

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