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Early-onset inflammatory bowel disease and common variable immunodeficiency-like disease caused by IL-21 deficiency

Abstract : BACKGROUND: Alterations of immune homeostasis in the gut can result in development of inflammatory bowel disease (IBD). Recently, Mendelian forms of IBD have been discovered, as exemplified by deficiency of IL-10 or its receptor subunits. In addition, other types of primary immunodeficiency disorders might be associated with intestinal inflammation as one of their leading clinical presentations. OBJECTIVE: We investigated a large consanguineous family with 3 children who presented with early-onset IBD within the first year of life, leading to death in infancy in 2 of them. METHODS: Homozygosity mapping combined with exome sequencing was performed to identify the molecular cause of the disorder. Functional experiments were performed to assess the effect of IL-21 on the immune system. RESULTS: A homozygous mutation in IL21 was discovered that showed perfect segregation with the disease. Deficiency of IL-21 resulted in reduced numbers of circulating CD19(+) B cells, including IgM(+) naive and class-switched IgG memory B cells, with a concomitant increase in transitional B-cell numbers. In vitro assays demonstrated that mutant IL-21(Leu49Pro) did not induce signal transducer and activator of transcription 3 phosphorylation and immunoglobulin class-switch recombination. CONCLUSION: Our study uncovers IL-21 deficiency as a novel cause of early-onset IBD in human subjects accompanied by defects in B-cell development similar to those found in patients with common variable immunodeficiency. IBD might mask an underlying primary immunodeficiency, as illustrated here with IL-21 deficiency.
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Soumis le : vendredi 28 juin 2019 - 13:50:49
Dernière modification le : lundi 1 juillet 2019 - 09:45:21




E. Salzer, A. Kansu, H. Sic, P. Majek, A. Ikinciogullari, et al.. Early-onset inflammatory bowel disease and common variable immunodeficiency-like disease caused by IL-21 deficiency. Journal of Allergy and Clinical Immunology, Elsevier, 2014, 133, pp.1651--9 e12. ⟨10.1016/j.jaci.2014.02.034⟩. ⟨hal-02168078⟩



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