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10.1016/j.jaci.2014.03.025

http://scihub22266oqcxt.onion/10.1016/j.jaci.2014.03.025
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C4132167!4132167!24797421
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suck abstract from ncbi


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pmid24797421      J+Allergy+Clin+Immunol 2014 ; 133 (6): 1667-75
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  • Somatic reversion in DOCK8 immunodeficiency modulates disease phenotype #MMPMID24797421
  • Jing H; Zhang Q; Zhang Y; Hill BJ; Dove CG; Gelfand EW; Atkinson TP; Uzel G; Matthews HF; Mustillo PJ; Lewis DB; Kavadas FD; Hanson IC; Kumar AR; Geha RS; Douek DC; Holland SM; Freeman AF; Su HC
  • J Allergy Clin Immunol 2014[Jun]; 133 (6): 1667-75 PMID24797421show ga
  • Background: Autosomal recessive, loss-of-function mutations in DOCK8 cause a combined immunodeficiency characterized by atopy, recurrent infections, and cancer susceptibility. A genotype-phenotype explanation for the variable disease expression is lacking. Objective: We investigated whether reversions contributed to the variable disease expression. Methods: Patients followed at the NIH Clinical Center were studied. We performed detailed genetic analyses and intracellular flow cytometry to detect DOCK8 protein expression within lymphocyte subsets. Results: We identified 17 out of 34 DOCK8-deficient patients who had germline mutations with variable degrees of reversion due to somatic repair. Somatic repair of the DOCK8 mutations resulted from second-site mutation, original-site mutation, gene conversion, and intragenic crossover. Higher degrees of reversion were associated with recombination-mediated repair. DOCK8 expression was restored primarily within antigen-experienced T cells or in NK cells, but less so in naïve T cells or B cells. Several patients exhibited multiple different repair events. Patients who had reversions were older and had less severe allergic disease, although infection susceptibility persisted. No patients were cured without hematopoietic cell transplantation. Conclusions: In DOCK8 deficiency, only certain combinations of germline mutations supported secondary somatic repair. Those patients had an ameliorated disease course with longer survival, but still had fatal complications or required hematopoietic cell transplantation. These observations support the concept that some DOCK8 immunodeficient patients have mutable mosaic genomes that may modulate disease phenotype over time.
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