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Blood, 7 May 2009, Vol. 113, No. 19, pp. 4740-4746.
Prepublished online as a Blood First Edition Paper on December 8, 2008; DOI 10.1182/blood-2008-10-182154.


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Submitted October 2, 2008
Accepted December 1, 2008

LAD-1/variant syndrome is caused by mutations in FERMT3

Taco W. Kuijpers*, Edith van de Vijver, Marian A.J. Weterman, Martin de Boer, Anton T.J. Tool, Timo K. van den Berg, Markus Moser, Marja E Jakobs, Karl Seeger, Ozden Sanal, Sule Unal, Mualla Cetin, Dirk Roos, Arthur J Verhoeven, and Frank Baas

Emma Children's Hospital, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, Netherlands
Department of Blood Cell Research, Sanquin Research and Landsteiner Laboratory, AMC, University of Amsterdam, Amsterdam, Netherlands
Department of Neurogenetics, Genetic Core Facility, AMC, University of Amsterdam, Amsterdam, Netherlands
Department of Molecular Medicine, Max Planck Institute of Biochemistry, Martinsried, Germany
Department of Pediatric Oncology/Hematology, Otto-Heubner-Center for Pediatric and Adolescent Medicine, Charite-Universitatstmedizin, Berlin, Germany
Pediatric Immunology Unit, Hacettepe University, Ankara, Turkey
Pediatric Hematology Unit, Hacettepe University, Ankara, Turkey

* Corresponding author; email: t.w.kuijpers{at}amc.uva.nl.

Leukocyte Adhesion Deficiency-1/variant (LAD1v) syndrome presents early in life and manifests by infections without pus formation in the presence of a leukocytosis combined with a Glanzmann-type bleeding disorder, due to a hematopoietic defect in integrin activation. In 7 consanguineous families, we previously established that this defect was not due to defective Rap1 activation as proposed by other investigators. In search of the genetic defect, we carried out homozygosity mapping in 3 of these patients, and a 13-Mb region on chromosome 11 was identified. All 7 LAD1v families share the same haplotype, in which three disease-associated sequence variants were identified: a putative splice site mutation in CALDAGGEF1 (encoding an exchange factor for Rap1), an intronic 1.8-kb deletion in NRXN2 and a premature stopcodon (p.Arg509X) in FERMT3. Two other LAD1v patients were found to carry different stopcodons in FERMT3 (p.Arg573X and p.Trp229X) and lacked the CALDAGGEF1 and NRXN2 mutations, providing convincing evidence that FERMT3 is the gene responsible for LAD1v. FERMT3 encodes kindlin-3 in hematopoietic cells, a protein present together with integrins in focal adhesions. Kindlin-3 protein expression was undetectable in the leukocytes and platelets of all patients tested. These results indicate that LAD-1/variant syndrome is caused by truncating mutations in FERMT3.


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