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Combined Immunodeficiency Associated with Increased Apoptosis of Lymphocytes and Radiosensitivity of Fibroblasts¹

Institute National de la Santé et de la Recherche Médicale U429, Hopital Necker Enfants Malades, Pavillon Kirmisson, 75743 Paris Cedex 15, France [J. P., F. L. D., F. R-L., J-P. d. V., A. F., C. H.]; Medical Research Council Cell Mutation Unit, University of Sussex, Falmer, Brighton, East Sussex BN1 9RR, United Kingdom [A. W., A. P., E. C., B. K. S., P. A. J.]; Institut Gustave-Roussy, 94805 Villejuif, France [N. F., E. P. M.]; and Pediatric Immunology and Infectious Diseases Unit, Newcastle General Hospital, Newcastle upon Tyne, NE4 6BE, United Kingdom [A. C.]

Severe immunodeficiency characterized by lymphopenia was found in two siblings, one of whom was examined in detail. The calcium flux, pattern of tyrosine phosphorylation of proteins, and interleukin 2 (IL-2) production and proliferation in response to mitogens suggested that the peripheral blood T cells activated normally. The peripheral blood T cells were shown to have an activated phenotype with increased expression of CD45RO+ and CD95/Fas. Increased spontaneous apoptosis occurred in unstimulated lymphocyte cultures. The elevated apoptosis was not due to alterations in expression or to mutations in Bcl-2, Bcl-X_L, or Flip, nor could the spontaneous apoptosis be prevented by blocking Fas, suggesting that it was independent of Fas signaling. This is the first inherited combined immunodeficiency associated with impaired lymphocyte survival. Fibroblasts derived from the patient showed appreciable radiosensitivity in clonal assays, but apoptosis was not elevated. Our results show that the fibroblasts represent a new radiosensitive phenotype not associated with cell cycle checkpoint defects, V(D)J recombination defects, or elevated chromosome breakage. We suggest that the affected gene plays a role in an undetermined damage response mechanism that results in elevated spontaneous apoptosis in lymphoid cells and radiosensitivity in fibroblasts.

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