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Omenn's syndrome occurring in patients without mutations in recombination activating genes.
[omenn syndrome]
Omenn
syndrome
(
OS
)
is
characterised
by
hepatosplenomegaly
,
lymphadenopathy
,
erythema
,
eosinophilia
,
elevated
IgE
,
oligoclonal
T
cell
expansions
and
recombinase
activating
gene
(
RAG
)
mutations
.
We
investigated
9
cases
of
OS
to
correlate
genotype
with
immunophenotype
using
a
two
-color
flow
cytometry
with
monoclonal
antibodies
against
CD
3
and
TCRVB
families
to
map
TCRVB
usage
.
T
and
B
clonal
cell
populations
were
examined
in
peripheral
blood
lymphocytes
by
PCR
and
sequencing
of
TCRB
/
TCRG
T
cell
and
IGH
FR
2
/
FR
3
B
cell
products
.
RAG
and
Artemis
genes
were
sequenced
from
genomic
DNA
.
All
patients
demonstrated
absent
TCRVB
families
;
six
had
predominant
TCRVB
families
,
six
oligoclonal
TCR
gene
rearrangements
including
TCRGD
rearrangements
.
One
demonstrated
functional
IGH
rearrangement
,
an
observation
not
previously
reported
.
In
this
clinically
homogeneous
population
,
with
similar
immunological
phenotype
,
RAG
mutations
were
identified
in
only
2
/
9
patients
.
OS
is
a
genetically
heterogeneous
condition
,
and
patients
with
similar
immunophenotypes
may
have
as
yet
unidentified
gene
defects
.
Diseases
Validation
Diseases presenting
"hepatosplenomegaly"
symptom
alpha-thalassemia
erdheim-chester disease
erythropoietic protoporphyria
gm1 gangliosidosis
homocystinuria without methylmalonic aciduria
neonatal adrenoleukodystrophy
oculocutaneous albinism
omenn syndrome
severe combined immunodeficiency
waldenström macroglobulinemia
zellweger syndrome
This symptom has already been validated