Molecular defects in human severe combined immunodeficiency and approaches to immune reconstitution.

Published

Journal Article (Review)

Mutations in nine different genes have been found to cause the human severe combined immunodeficiency syndrome. The products of three of the genes--IL-2RG, Jak3, and IL-7R alpha--are components of cytokine receptors, and the products of three more-RAG1, RAG2, and Artemis-are essential for effecting antigen receptor gene rearrangement. Additionally, a deficiency of CD3 delta, a component of the T-cell antigen receptor, results in a near absence of circulating mature CD3+ T cells and a complete lack of gamma/delta T cells. Adenosine deaminase deficiency results in toxic accumulations of metabolites that cause T cell apoptosis. Finally, a deficiency of CD45, a critical regulator of signaling thresholds in immune cells, also causes SCID. Approaches to immune reconstitution have included bone marrow transplantation and gene therapy. Bone marrow transplantation, both HLA identical unfractionated and T cell-depleted HLA haploidentical, has been very successful in effecting immune reconstitution if done in the first 3.5 months of life and without pretransplant chemotherapy. Gene therapy was highly successful in nine infants with X-linked SCID, but the trials have been placed on hold due to the development of a leukemic process in two of the children because of insertional oncogenesis.

Full Text

Duke Authors

Cited Authors

  • Buckley, RH

Published Date

  • 2004

Published In

Volume / Issue

  • 22 /

Start / End Page

  • 625 - 655

PubMed ID

  • 15032591

Pubmed Central ID

  • 15032591

International Standard Serial Number (ISSN)

  • 0732-0582

Digital Object Identifier (DOI)

  • 10.1146/annurev.immunol.22.012703.104614

Language

  • eng

Conference Location

  • United States