Germline hypomorphic CARD11 mutations in severe atopic disease

  • Nat Genet. 2017 Aug;49(8):1192-1201. doi: 10.1038/ng.3898.
Chi A Ma  1 Jeffrey R Stinson  2 Yuan Zhang  1 Jordan K Abbott  3 Michael A Weinreich  1 Pia J Hauk  3 Paul R Reynolds  3 Jonathan J Lyons  1 Celeste G Nelson  1 Elisa Ruffo  2  4 Batsukh Dorjbal  2 Salomé Glauzy  5 Natsuko Yamakawa  5 Swadhinya Arjunaraja  2 Kelsey Voss  2 Jennifer Stoddard  6 Julie Niemela  6 Yu Zhang  7 Sergio D Rosenzweig  6 Joshua J McElwee  8 Thomas DiMaggio  1 Helen F Matthews  7 Nina Jones  9 Kelly D Stone  1 Alejandro Palma  10 Matías Oleastro  10 Emma Prieto  10 Andrea R Bernasconi  10 Geronimo Dubra  10 Silvia Danielian  10 Jonathan Zaiat  10 Marcelo A Marti  10 Brian Kim  11 Megan A Cooper  12 Neil Romberg  13 Eric Meffre  5 Erwin W Gelfand  3 Andrew L Snow  2 Joshua D Milner  1
Affiliations
  • 1. Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
  • 2. Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
  • 3. Immunodeficiency Diagnosis and Treatment Program, Department of Pediatrics, National Jewish Health, Denver, Colorado, USA.
  • 4. Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.
  • 5. Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, USA.
  • 6. Immunology Service, Department of Laboratory Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA.
  • 7. Human Immunological Disease Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
  • 8. Merck Research Laboratories, Merck and Co., Inc., Boston, Massachusetts, USA.
  • 9. Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., NCI Campus at Frederick, Frederick, Maryland, USA.
  • 10. Servicio de Immunología y Reumatología, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
  • 11. Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
  • 12. Department of Pediatrics, Division of Rheumatology and Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA.
  • 13. Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Abstract

Few monogenic causes for severe manifestations of common allergic diseases have been identified. Through next-generation Sequencing on a cohort of patients with severe atopic dermatitis with and without comorbid infections, we found eight individuals, from four families, with novel heterozygous mutations in CARD11, which encodes a scaffolding protein involved in lymphocyte receptor signaling. Disease improved over time in most patients. Transfection of mutant CARD11 expression constructs into T cell lines demonstrated both loss-of-function and dominant-interfering activity upon antigen receptor-induced activation of nuclear factor-κB and mammalian target of rapamycin complex 1 (mTORC1). Patient T cells had similar defects, as well as low production of the cytokine interferon-γ (IFN-γ). The mTORC1 and IFN-γ production defects were partially rescued by supplementation with glutamine, which requires CARD11 for import into T cells. Our findings indicate that a single hypomorphic mutation in CARD11 can cause potentially correctable cellular defects that lead to atopic dermatitis.