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2016 ; 62
(8
): 986-94
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Progressive Multifocal Leukoencephalopathy in Primary Immune Deficiencies: Stat1
Gain of Function and Review of the Literature
#MMPMID26743090
Zerbe CS
; Marciano BE
; Katial RK
; Santos CB
; Adamo N
; Hsu AP
; Hanks ME
; Darnell DN
; Quezado MM
; Frein C
; Barnhart LA
; Anderson VL
; Uzel G
; Freeman AF
; Lisco A
; Nath A
; Major EO
; Sampaio EP
; Holland SM
Clin Infect Dis
2016[Apr]; 62
(8
): 986-94
PMID26743090
show ga
BACKGROUND: Progressive multifocal leukoencephalopathy (PML) is a rare, severe,
otherwise fatal viral infection of the white matter of the brain caused by the
polyomavirus JC virus, which typically occurs only in immunocompromised patients.
One patient with dominant gain-of-function (GOF) mutation in signal transducer
and activator of transcription 1 (STAT1) with chronic mucocutaneous candidiasis
and PML was reported previously. We aim to identify the molecular defect in 3
patients with PML and to review the literature on PML in primary immune defects
(PIDs). METHODS: STAT1 was sequenced in 3 patients with PML. U3C cell lines were
transfected with STAT1 and assays to search for STAT1 phosphorylation,
transcriptional response, and target gene expression were performed. RESULTS: We
identified 3 new unrelated cases of PML in patients with GOF STAT1 mutations,
including the novel STAT1 mutation, L400Q. These STAT1 mutations caused delayed
STAT1 dephosphorylation and enhanced interferon-gamma-driven responses. In our
review of the literature regarding PML in primary immune deficiencies we found 26
cases, only 54% of which were molecularly characterized, the remainder being
syndromically diagnosed only. CONCLUSIONS: The occurrence of PML in 4 cases of
STAT1 GOF suggests that STAT1 plays a critical role in the control of JC virus in
the central nervous system.