Predominantly antibody deficiency: Difference between revisions

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{{ID}}
{{ID}}


{{CMG}}; {{AE}} {{Akram}}, {{Anmol}}
{{CMG}}; {{AE}} {{Preeti}}, {{Akram}}, {{Anmol}}


==Overview==
==Overview==
Predominantly antibody deficiencies (PAD) are the most common type of [[primary immunodeficiency diseases]] (PID). PAD is a large group of diseases which may vary widely from having a complete absence of [[B cells]] and decrease in all [[immunoglobulins]] to having deficiency in specific [[immunoglobulins]]. Depending on the phenotype, [[agammaglobulinemia]] or [[CVID]], patients can present either in infancy or adulthood.The main clinical characteristic of patients with PAD is recurrent bacterial infections, low levels of [[immunoglobulin]] (ranging from [[agammaglobulinemia]] to [[hypogammaglobulinemia]]), and impaired response to [[vaccines]] and antigens. Treatment is by intravenous or subcutaneous [[immunoglobulins]] and treatment of infections by [[antibiotics]].


==Classification==
==Classification==
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*Physical examination typically shows absence of [[Lymph node|lymph nodes]].
*Physical examination typically shows absence of [[Lymph node|lymph nodes]].
*Patients are susceptible to recurrent infections with [[Polysaccharide encapsulated bacteria|encapsulated organisms]] and [[Enterovirus|enteroviruses]], primarily effecting respiratory and gastrointestinal tracts.
*Patients are susceptible to recurrent infections with [[Polysaccharide encapsulated bacteria|encapsulated organisms]] and [[Enterovirus|enteroviruses]], primarily effecting respiratory and gastrointestinal tracts.
*Laboratory findings show defect in [[humoral immunity]] with absence or negligible amount of IgM, IgG, and IgA, as well as <2% of B cells lymphocytes. Neutropenia can also be seen.<ref name="pmid19597006">{{cite journal |vauthors=Fried AJ, Bonilla FA |title=Pathogenesis, diagnosis, and management of primary antibody deficiencies and infections |journal=Clin. Microbiol. Rev. |volume=22 |issue=3 |pages=396–414 |date=July 2009 |pmid=19597006 |pmc=2708392 |doi=10.1128/CMR.00001-09 |url=}}</ref><ref name="pmid24909997">{{cite journal |vauthors=Hernandez-Trujillo VP, Scalchunes C, Cunningham-Rundles C, Ochs HD, Bonilla FA, Paris K, Yel L, Sullivan KE |title=Autoimmunity and inflammation in X-linked agammaglobulinemia |journal=J. Clin. Immunol. |volume=34 |issue=6 |pages=627–32 |date=August 2014 |pmid=24909997 |pmc=4157090 |doi=10.1007/s10875-014-0056-x |url=}}</ref><ref name="pmid24215410">{{cite journal |vauthors=Berglöf A, Turunen JJ, Gissberg O, Bestas B, Blomberg KE, Smith CI |title=Agammaglobulinemia: causative mutations and their implications for novel therapies |journal=Expert Rev Clin Immunol |volume=9 |issue=12 |pages=1205–21 |date=December 2013 |pmid=24215410 |doi=10.1586/1744666X.2013.850030 |url=}}</ref>
*Laboratory findings show defect in [[humoral immunity]] with absence or negligible amount of [[IgM]], [[Immunoglobulin G|IgG]], and [[Immunoglobulin A|IgA]], as well as <2% of B cells lymphocytes. Neutropenia can also be seen.<ref name="pmid19597006">{{cite journal |vauthors=Fried AJ, Bonilla FA |title=Pathogenesis, diagnosis, and management of primary antibody deficiencies and infections |journal=Clin. Microbiol. Rev. |volume=22 |issue=3 |pages=396–414 |date=July 2009 |pmid=19597006 |pmc=2708392 |doi=10.1128/CMR.00001-09 |url=}}</ref><ref name="pmid24909997">{{cite journal |vauthors=Hernandez-Trujillo VP, Scalchunes C, Cunningham-Rundles C, Ochs HD, Bonilla FA, Paris K, Yel L, Sullivan KE |title=Autoimmunity and inflammation in X-linked agammaglobulinemia |journal=J. Clin. Immunol. |volume=34 |issue=6 |pages=627–32 |date=August 2014 |pmid=24909997 |pmc=4157090 |doi=10.1007/s10875-014-0056-x |url=}}</ref><ref name="pmid24215410">{{cite journal |vauthors=Berglöf A, Turunen JJ, Gissberg O, Bestas B, Blomberg KE, Smith CI |title=Agammaglobulinemia: causative mutations and their implications for novel therapies |journal=Expert Rev Clin Immunol |volume=9 |issue=12 |pages=1205–21 |date=December 2013 |pmid=24215410 |doi=10.1586/1744666X.2013.850030 |url=}}</ref>
*Treatment is mainly via  hematopoietic stem cell therapy and through replacement of [[immunoglobulins]] either by intravenous or subcutaneous routes. Recurrent infections are  prevented and treated by antibiotics.<ref name="pmid21466548">{{cite journal |vauthors=Cunningham-Rundles C |title=Key aspects for successful immunoglobulin therapy of primary immunodeficiencies |journal=Clin. Exp. Immunol. |volume=164 Suppl 2 |issue= |pages=16–9 |date=June 2011 |pmid=21466548 |pmc=3087906 |doi=10.1111/j.1365-2249.2011.04390.x |url=}}</ref>
*Treatment is mainly via  [[Hematopoietic stem cell transplantation|hematopoietic stem cell therapy]] and through replacement of [[immunoglobulins]] either by intravenous or subcutaneous routes. Recurrent infections are  prevented and treated by [[Antibiotic|antibiotics]].<ref name="pmid21466548">{{cite journal |vauthors=Cunningham-Rundles C |title=Key aspects for successful immunoglobulin therapy of primary immunodeficiencies |journal=Clin. Exp. Immunol. |volume=164 Suppl 2 |issue= |pages=16–9 |date=June 2011 |pmid=21466548 |pmc=3087906 |doi=10.1111/j.1365-2249.2011.04390.x |url=}}</ref>


For more information on [[X-linked agammaglobulinemia]], [[X-linked agammaglobulinemia|click here]].
For more information on [[X-linked agammaglobulinemia]], [[X-linked agammaglobulinemia|click here]].


==µ Heavy Chain Deficiency==
==µ Heavy Chain Deficiency==
*[[Autosomal recessive]] (AR) transmission.
*µ heavy chain deficiency has [[Autosomal recessive]] (AR) transmission.
*It is caused by mutation of µ heavy chain (IGHM) on [[chromosome]] 14.<ref name="pmid8890099">{{cite journal |vauthors=Yel L, Minegishi Y, Coustan-Smith E, Buckley RH, Trübel H, Pachman LM, Kitchingman GR, Campana D, Rohrer J, Conley ME |title=Mutations in the mu heavy-chain gene in patients with agammaglobulinemia |journal=N. Engl. J. Med. |volume=335 |issue=20 |pages=1486–93 |date=November 1996 |pmid=8890099 |doi=10.1056/NEJM199611143352003 |url=}}</ref>
*It is caused by mutation of µ heavy chain (IGHM) on [[chromosome]] 14.<ref name="pmid8890099">{{cite journal |vauthors=Yel L, Minegishi Y, Coustan-Smith E, Buckley RH, Trübel H, Pachman LM, Kitchingman GR, Campana D, Rohrer J, Conley ME |title=Mutations in the mu heavy-chain gene in patients with agammaglobulinemia |journal=N. Engl. J. Med. |volume=335 |issue=20 |pages=1486–93 |date=November 1996 |pmid=8890099 |doi=10.1056/NEJM199611143352003 |url=}}</ref>
*This mutation is phenotypically similar to [[X-linked agammaglobulinemia]], but unlike [[X-linked agammaglobulinemia]] can also be seen in females, yet there has been a study that provides data showing clinically significant difference between the two.<ref name="pmid26910880">{{cite journal |vauthors=Abolhassani H, Vitali M, Lougaris V, Giliani S, Parvaneh N, Parvaneh L, Mirminachi B, Cheraghi T, Khazaei H, Mahdaviani SA, Kiaei F, Tavakolinia N, Mohammadi J, Negahdari B, Rezaei N, Hammarstrom L, Plebani A, Aghamohammadi A |title=Cohort of Iranian Patients with Congenital Agammaglobulinemia: Mutation Analysis and Novel Gene Defects |journal=Expert Rev Clin Immunol |volume=12 |issue=4 |pages=479–86 |date=2016 |pmid=26910880 |doi=10.1586/1744666X.2016.1139451 |url=}}</ref>
*This mutation is phenotypically similar to [[X-linked agammaglobulinemia]], but unlike [[X-linked agammaglobulinemia]] can also be seen in females, yet there has been a study that provides data showing clinically significant difference between the two.<ref name="pmid26910880">{{cite journal |vauthors=Abolhassani H, Vitali M, Lougaris V, Giliani S, Parvaneh N, Parvaneh L, Mirminachi B, Cheraghi T, Khazaei H, Mahdaviani SA, Kiaei F, Tavakolinia N, Mohammadi J, Negahdari B, Rezaei N, Hammarstrom L, Plebani A, Aghamohammadi A |title=Cohort of Iranian Patients with Congenital Agammaglobulinemia: Mutation Analysis and Novel Gene Defects |journal=Expert Rev Clin Immunol |volume=12 |issue=4 |pages=479–86 |date=2016 |pmid=26910880 |doi=10.1586/1744666X.2016.1139451 |url=}}</ref>
*Treatment is mainly via replacement of [[immunoglobulins]] by intravenous or subcutaneous routes, hematopoietic stem cell therapy and use of prophylactic and curative [[antibiotics]].<ref name="pmid21466548">{{cite journal |vauthors=Cunningham-Rundles C |title=Key aspects for successful immunoglobulin therapy of primary immunodeficiencies |journal=Clin. Exp. Immunol. |volume=164 Suppl 2 |issue= |pages=16–9 |date=June 2011 |pmid=21466548 |pmc=3087906 |doi=10.1111/j.1365-2249.2011.04390.x |url=}}</ref>
*Treatment is mainly via replacement of [[immunoglobulins]] by intravenous or subcutaneous routes, [[Hematopoietic stem cell transplantation|hematopoietic stem cell therapy]] and use of prophylactic and curative [[antibiotics]].<ref name="pmid21466548">{{cite journal |vauthors=Cunningham-Rundles C |title=Key aspects for successful immunoglobulin therapy of primary immunodeficiencies |journal=Clin. Exp. Immunol. |volume=164 Suppl 2 |issue= |pages=16–9 |date=June 2011 |pmid=21466548 |pmc=3087906 |doi=10.1111/j.1365-2249.2011.04390.x |url=}}</ref>


==Igα Deficiency==
==Igα Deficiency==
*[[Autosomal recessive]] (AR) transmission.
*Igα Deficiency has [[autosomal recessive]] (AR) transmission.
*Mutation of Igα(CD79α) a component of [[B cell receptor]] (BCR). Mutations in Pre-BCR complex many times lead to truncation of [[B cell]] development.
*Mutation of Igα(CD79α) a component of [[B cell receptor]] (BCR). Mutations in pre-BCR complex many times lead to truncation of [[B cell]] development.
*It causes a [[B cell]] defect which leads to a clinical picture similar to [[X-linked agammaglobulinemia]].
*It causes a [[B cell]] defect which leads to a clinical picture similar to [[X-linked agammaglobulinemia]].
* Patients have increased susceptibility to [[bacterial]] infections and [[otitis media]].
* Patients have increased susceptibility to [[bacterial]] infections and [[otitis media]].
* Diagnosis is mainly by [[polymerase chain reaction]] (PCR) or [[single starnd conformational polymosrphism analysis]](SSCA).<ref name="pmid11920841">{{cite journal |vauthors=Wang Y, Kanegane H, Sanal O, Tezcan I, Ersoy F, Futatani T, Miyawaki T |title=Novel Igalpha (CD79a) gene mutation in a Turkish patient with B cell-deficient agammaglobulinemia |journal=Am. J. Med. Genet. |volume=108 |issue=4 |pages=333–6 |date=April 2002 |pmid=11920841 |doi= |url=}}</ref>
* Diagnosis is mainly by [[polymerase chain reaction]] (PCR) or single strand conformational polymosrphism analysis(SSCA).<ref name="pmid11920841">{{cite journal |vauthors=Wang Y, Kanegane H, Sanal O, Tezcan I, Ersoy F, Futatani T, Miyawaki T |title=Novel Igalpha (CD79a) gene mutation in a Turkish patient with B cell-deficient agammaglobulinemia |journal=Am. J. Med. Genet. |volume=108 |issue=4 |pages=333–6 |date=April 2002 |pmid=11920841 |doi= |url=}}</ref>
*Treatment is mainly through replacement of [[immunoglobulins]] by intravenous or subcutaneous routes, hematopoietic stem cell therapy and use of prophylactic and curative [[antibiotics]].<ref name="pmid21276714">{{cite journal |vauthors=Maarschalk-Ellerbroek LJ, Hoepelman IM, Ellerbroek PM |title=Immunoglobulin treatment in primary antibody deficiency |journal=Int. J. Antimicrob. Agents |volume=37 |issue=5 |pages=396–404 |date=May 2011 |pmid=21276714 |doi=10.1016/j.ijantimicag.2010.11.027 |url=}}</ref>.
*Treatment is mainly through replacement of [[immunoglobulins]] by intravenous or subcutaneous routes, [[Hematopoietic stem cell transplantation|hematopoietic stem cell therapy]] and use of prophylactic and curative [[antibiotics]].<ref name="pmid21276714">{{cite journal |vauthors=Maarschalk-Ellerbroek LJ, Hoepelman IM, Ellerbroek PM |title=Immunoglobulin treatment in primary antibody deficiency |journal=Int. J. Antimicrob. Agents |volume=37 |issue=5 |pages=396–404 |date=May 2011 |pmid=21276714 |doi=10.1016/j.ijantimicag.2010.11.027 |url=}}</ref>.


==Igβ Deficiency==
==Igβ Deficiency==
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*Igβ is a signal transduction molecule similar to Igα and is essential for [[B cell receptor]](BCR) expression.
*Igβ is a signal transduction molecule similar to Igα and is essential for [[B cell receptor]](BCR) expression.
*Patients generally present with reduced [[immunoglobulins]] which leads to frequent bacterial infections of upper and lower respiratory tract similar to other [[X-linked agammaglobulinemia|agammaglobulinemia]] like [[X-linked agammaglobulinemia]].<ref name="pmid17709424">{{cite journal |vauthors=Ferrari S, Lougaris V, Caraffi S, Zuntini R, Yang J, Soresina A, Meini A, Cazzola G, Rossi C, Reth M, Plebani A |title=Mutations of the Igbeta gene cause agammaglobulinemia in man |journal=J. Exp. Med. |volume=204 |issue=9 |pages=2047–51 |date=September 2007 |pmid=17709424 |pmc=2118692 |doi=10.1084/jem.20070264 |url=}}</ref><ref name="pmid17675462">{{cite journal |vauthors=Dobbs AK, Yang T, Farmer D, Kager L, Parolini O, Conley ME |title=Cutting edge: a hypomorphic mutation in Igbeta (CD79b) in a patient with immunodeficiency and a leaky defect in B cell development |journal=J. Immunol. |volume=179 |issue=4 |pages=2055–9 |date=August 2007 |pmid=17675462 |doi= |url=}}</ref>
*Patients generally present with reduced [[immunoglobulins]] which leads to frequent bacterial infections of upper and lower respiratory tract similar to other [[X-linked agammaglobulinemia|agammaglobulinemia]] like [[X-linked agammaglobulinemia]].<ref name="pmid17709424">{{cite journal |vauthors=Ferrari S, Lougaris V, Caraffi S, Zuntini R, Yang J, Soresina A, Meini A, Cazzola G, Rossi C, Reth M, Plebani A |title=Mutations of the Igbeta gene cause agammaglobulinemia in man |journal=J. Exp. Med. |volume=204 |issue=9 |pages=2047–51 |date=September 2007 |pmid=17709424 |pmc=2118692 |doi=10.1084/jem.20070264 |url=}}</ref><ref name="pmid17675462">{{cite journal |vauthors=Dobbs AK, Yang T, Farmer D, Kager L, Parolini O, Conley ME |title=Cutting edge: a hypomorphic mutation in Igbeta (CD79b) in a patient with immunodeficiency and a leaky defect in B cell development |journal=J. Immunol. |volume=179 |issue=4 |pages=2055–9 |date=August 2007 |pmid=17675462 |doi= |url=}}</ref>
*Treatment is mainly via replacement of [[immunoglobulins]] by intravenous or subcutaneous routes, hematopoietic stem cell therapy and use of prophylactic and curative [[antibiotics]].<ref name="pmid17675462">{{cite journal |vauthors=Dobbs AK, Yang T, Farmer D, Kager L, Parolini O, Conley ME |title=Cutting edge: a hypomorphic mutation in Igbeta (CD79b) in a patient with immunodeficiency and a leaky defect in B cell development |journal=J. Immunol. |volume=179 |issue=4 |pages=2055–9 |date=August 2007 |pmid=17675462 |doi= |url=}}</ref>
*Treatment is mainly via replacement of [[immunoglobulins]] by intravenous or subcutaneous route, [[Hematopoietic stem cell transplantation|hematopoietic stem cell therapy]] and use of prophylactic and curative [[antibiotics]].<ref name="pmid17675462">{{cite journal |vauthors=Dobbs AK, Yang T, Farmer D, Kager L, Parolini O, Conley ME |title=Cutting edge: a hypomorphic mutation in Igbeta (CD79b) in a patient with immunodeficiency and a leaky defect in B cell development |journal=J. Immunol. |volume=179 |issue=4 |pages=2055–9 |date=August 2007 |pmid=17675462 |doi= |url=}}</ref>


==BLNK Deficiency==
==BLNK Deficiency==
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*BLNK gene on [[chromosome]] 10 encodes for a scaffold molecule B cell linker protein (BLNK, SLC-65) and is crucial for the development of pre B cell.
*BLNK gene on [[chromosome]] 10 encodes for a scaffold molecule B cell linker protein (BLNK, SLC-65) and is crucial for the development of pre B cell.
*Patients generally present with recurrent [[Bacteria|bacterial]] infections, [[otitis media]] and upper and lower respiratory tract infections similar to [[X-linked agammaglobulinemia]].<ref name="pmid10583958">{{cite journal |vauthors=Minegishi Y, Rohrer J, Coustan-Smith E, Lederman HM, Pappu R, Campana D, Chan AC, Conley ME |title=An essential role for BLNK in human B cell development |journal=Science |volume=286 |issue=5446 |pages=1954–7 |date=December 1999 |pmid=10583958 |doi= |url=}}</ref>
*Patients generally present with recurrent [[Bacteria|bacterial]] infections, [[otitis media]] and upper and lower respiratory tract infections similar to [[X-linked agammaglobulinemia]].<ref name="pmid10583958">{{cite journal |vauthors=Minegishi Y, Rohrer J, Coustan-Smith E, Lederman HM, Pappu R, Campana D, Chan AC, Conley ME |title=An essential role for BLNK in human B cell development |journal=Science |volume=286 |issue=5446 |pages=1954–7 |date=December 1999 |pmid=10583958 |doi= |url=}}</ref>
*Treatment is mainly via replacement of [[immunoglobulins]] by intravenous or subcutaneous routes, hematopoietic stem cell therapy and use of prophylactic and curative [[antibiotics]].<ref name="pmid21276714">{{cite journal |vauthors=Maarschalk-Ellerbroek LJ, Hoepelman IM, Ellerbroek PM |title=Immunoglobulin treatment in primary antibody deficiency |journal=Int. J. Antimicrob. Agents |volume=37 |issue=5 |pages=396–404 |date=May 2011 |pmid=21276714 |doi=10.1016/j.ijantimicag.2010.11.027 |url=}}</ref>
*Treatment is mainly via replacement of [[immunoglobulins]] by intravenous or subcutaneous routes, [[Hematopoietic stem cell transplantation|hematopoietic stem cell therapy]] and use of prophylactic and curative [[antibiotics]].<ref name="pmid21276714">{{cite journal |vauthors=Maarschalk-Ellerbroek LJ, Hoepelman IM, Ellerbroek PM |title=Immunoglobulin treatment in primary antibody deficiency |journal=Int. J. Antimicrob. Agents |volume=37 |issue=5 |pages=396–404 |date=May 2011 |pmid=21276714 |doi=10.1016/j.ijantimicag.2010.11.027 |url=}}</ref>


==λ5 Deficiency==
==λ5 Deficiency==
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*It is caused by mutation of λ5 (IGLL1), component of [[B cell receptor]], on [[chromosome]] 22.
*It is caused by mutation of λ5 (IGLL1), component of [[B cell receptor]], on [[chromosome]] 22.
*Leads to clinical features similar to [[X-linked agammaglobulinemia]].<ref name="pmid9419212">{{cite journal |vauthors=Minegishi Y, Coustan-Smith E, Wang YH, Cooper MD, Campana D, Conley ME |title=Mutations in the human lambda5/14.1 gene result in B cell deficiency and agammaglobulinemia |journal=J. Exp. Med. |volume=187 |issue=1 |pages=71–7 |date=January 1998 |pmid=9419212 |pmc=2199185 |doi= |url=}}</ref>
*Leads to clinical features similar to [[X-linked agammaglobulinemia]].<ref name="pmid9419212">{{cite journal |vauthors=Minegishi Y, Coustan-Smith E, Wang YH, Cooper MD, Campana D, Conley ME |title=Mutations in the human lambda5/14.1 gene result in B cell deficiency and agammaglobulinemia |journal=J. Exp. Med. |volume=187 |issue=1 |pages=71–7 |date=January 1998 |pmid=9419212 |pmc=2199185 |doi= |url=}}</ref>
*Treatment is mainly through replacement of [[immunoglobulins]] by intravenous or subcutaneous routes, hematopoietic stem cell therapy and use of prophylactic and curative [[antibiotics]].<ref name="pmid21276714">{{cite journal |vauthors=Maarschalk-Ellerbroek LJ, Hoepelman IM, Ellerbroek PM |title=Immunoglobulin treatment in primary antibody deficiency |journal=Int. J. Antimicrob. Agents |volume=37 |issue=5 |pages=396–404 |date=May 2011 |pmid=21276714 |doi=10.1016/j.ijantimicag.2010.11.027 |url=}}</ref>
*Treatment is mainly through replacement of [[immunoglobulins]] by intravenous or subcutaneous routes, [[Hematopoietic stem cell transplantation|hematopoietic stem cell therapy]] and use of prophylactic and curative [[antibiotics]].<ref name="pmid21276714">{{cite journal |vauthors=Maarschalk-Ellerbroek LJ, Hoepelman IM, Ellerbroek PM |title=Immunoglobulin treatment in primary antibody deficiency |journal=Int. J. Antimicrob. Agents |volume=37 |issue=5 |pages=396–404 |date=May 2011 |pmid=21276714 |doi=10.1016/j.ijantimicag.2010.11.027 |url=}}</ref>


==PI3KR1 Deficiency==
==PI3KR1 Deficiency==
* PIK3R1 gene encodes for the p85α subunit of class IA phosphoinositide 3-kinases (PI3Ks).<ref name="pmid25133428">{{cite journal |vauthors=Deau MC, Heurtier L, Frange P, Suarez F, Bole-Feysot C, Nitschke P, Cavazzana M, Picard C, Durandy A, Fischer A, Kracker S |title=A human immunodeficiency caused by mutations in the PIK3R1 gene |journal=J. Clin. Invest. |volume=124 |issue=9 |pages=3923–8 |date=September 2014 |pmid=25133428 |pmc=4153704 |doi=10.1172/JCI75746 |url=}}</ref>
* PIK3R1 gene encodes for the p85α subunit of class IA phosphoinositide 3-kinases (PI3Ks).<ref name="pmid25133428">{{cite journal |vauthors=Deau MC, Heurtier L, Frange P, Suarez F, Bole-Feysot C, Nitschke P, Cavazzana M, Picard C, Durandy A, Fischer A, Kracker S |title=A human immunodeficiency caused by mutations in the PIK3R1 gene |journal=J. Clin. Invest. |volume=124 |issue=9 |pages=3923–8 |date=September 2014 |pmid=25133428 |pmc=4153704 |doi=10.1172/JCI75746 |url=}}</ref>
*Patients present with history of recurrent [[Bacteria|bacterial]] infections and positive family history, similar to clinical features seen in [[X-linked agammaglobulinemia]].<ref name="pmid7705412">{{cite journal |vauthors=de la Morena M, Haire RN, Ohta Y, Nelson RP, Litman RT, Day NK, Good RA, Litman GW |title=Predominance of sterile immunoglobulin transcripts in a female phenotypically resembling Bruton's agammaglobulinemia |journal=Eur. J. Immunol. |volume=25 |issue=3 |pages=809–15 |date=March 1995 |pmid=7705412 |doi=10.1002/eji.1830250327 |url=}}</ref>
*Patients present with history of recurrent [[Bacteria|bacterial]] infections and positive family history, similar to clinical features seen in [[X-linked agammaglobulinemia]].<ref name="pmid7705412">{{cite journal |vauthors=de la Morena M, Haire RN, Ohta Y, Nelson RP, Litman RT, Day NK, Good RA, Litman GW |title=Predominance of sterile immunoglobulin transcripts in a female phenotypically resembling Bruton's agammaglobulinemia |journal=Eur. J. Immunol. |volume=25 |issue=3 |pages=809–15 |date=March 1995 |pmid=7705412 |doi=10.1002/eji.1830250327 |url=}}</ref>
*Treatment is mainly through replacement of [[immunoglobulins]] by intravenous or subcutaneous routes, hematopoietic stem cell therapy and use of prophylactic and curative [[antibiotics]].<ref name="pmid21276714">{{cite journal |vauthors=Maarschalk-Ellerbroek LJ, Hoepelman IM, Ellerbroek PM |title=Immunoglobulin treatment in primary antibody deficiency |journal=Int. J. Antimicrob. Agents |volume=37 |issue=5 |pages=396–404 |date=May 2011 |pmid=21276714 |doi=10.1016/j.ijantimicag.2010.11.027 |url=}}</ref>
*Treatment is mainly through replacement of [[immunoglobulins]] by intravenous or subcutaneous routes, [[Hematopoietic stem cell transplantation|hematopoietic stem cell therapy]] and use of prophylactic and curative [[antibiotics]].<ref name="pmid21276714">{{cite journal |vauthors=Maarschalk-Ellerbroek LJ, Hoepelman IM, Ellerbroek PM |title=Immunoglobulin treatment in primary antibody deficiency |journal=Int. J. Antimicrob. Agents |volume=37 |issue=5 |pages=396–404 |date=May 2011 |pmid=21276714 |doi=10.1016/j.ijantimicag.2010.11.027 |url=}}</ref>


==E47 transcription factor Deficiency==
==E47 transcription factor Deficiency==
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*This mutation leads to improper differentiation of [[B cell]] from lymphoid precursors.<ref name="pmid24216514">{{cite journal |vauthors=Boisson B, Wang YD, Bosompem A, Ma CS, Lim A, Kochetkov T, Tangye SG, Casanova JL, Conley ME |title=A recurrent dominant negative E47 mutation causes agammaglobulinemia and BCR(-) B cells |journal=J. Clin. Invest. |volume=123 |issue=11 |pages=4781–5 |date=November 2013 |pmid=24216514 |pmc=3809807 |doi=10.1172/JCI71927 |url=}}</ref>
*This mutation leads to improper differentiation of [[B cell]] from lymphoid precursors.<ref name="pmid24216514">{{cite journal |vauthors=Boisson B, Wang YD, Bosompem A, Ma CS, Lim A, Kochetkov T, Tangye SG, Casanova JL, Conley ME |title=A recurrent dominant negative E47 mutation causes agammaglobulinemia and BCR(-) B cells |journal=J. Clin. Invest. |volume=123 |issue=11 |pages=4781–5 |date=November 2013 |pmid=24216514 |pmc=3809807 |doi=10.1172/JCI71927 |url=}}</ref>
*Patients present with few [[B cell|B cells]] characterized increased expression of [[CD19]], but without [[B cell receptor]] (BCR).<ref name="pmid21693761">{{cite journal |vauthors=Dobbs AK, Bosompem A, Coustan-Smith E, Tyerman G, Saulsbury FT, Conley ME |title=Agammaglobulinemia associated with BCR⁻ B cells and enhanced expression of CD19 |journal=Blood |volume=118 |issue=7 |pages=1828–37 |date=August 2011 |pmid=21693761 |pmc=3158715 |doi=10.1182/blood-2011-01-330472 |url=}}</ref>
*Patients present with few [[B cell|B cells]] characterized increased expression of [[CD19]], but without [[B cell receptor]] (BCR).<ref name="pmid21693761">{{cite journal |vauthors=Dobbs AK, Bosompem A, Coustan-Smith E, Tyerman G, Saulsbury FT, Conley ME |title=Agammaglobulinemia associated with BCR⁻ B cells and enhanced expression of CD19 |journal=Blood |volume=118 |issue=7 |pages=1828–37 |date=August 2011 |pmid=21693761 |pmc=3158715 |doi=10.1182/blood-2011-01-330472 |url=}}</ref>
*Treatment is mainly through replacement of [[immunoglobulins]] by intravenous or subcutaneous routes, hematopoietic stem cell therapy and use of prophylactic and curative [[antibiotics]].<ref name="pmid21276714">{{cite journal |vauthors=Maarschalk-Ellerbroek LJ, Hoepelman IM, Ellerbroek PM |title=Immunoglobulin treatment in primary antibody deficiency |journal=Int. J. Antimicrob. Agents |volume=37 |issue=5 |pages=396–404 |date=May 2011 |pmid=21276714 |doi=10.1016/j.ijantimicag.2010.11.027 |url=}}</ref>
*Treatment is mainly through replacement of [[immunoglobulins]] by intravenous or subcutaneous routes, [[Hematopoietic stem cell transplantation|hematopoietic stem cell therapy]] and use of prophylactic and curative [[antibiotics]].<ref name="pmid21276714">{{cite journal |vauthors=Maarschalk-Ellerbroek LJ, Hoepelman IM, Ellerbroek PM |title=Immunoglobulin treatment in primary antibody deficiency |journal=Int. J. Antimicrob. Agents |volume=37 |issue=5 |pages=396–404 |date=May 2011 |pmid=21276714 |doi=10.1016/j.ijantimicag.2010.11.027 |url=}}</ref>


==CVID With No Gene Specified==
==CVID With No Gene Specified==
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==PIK3CD mutation,PIK3R1 deficiency==
==PIK3CD mutation,PIK3R1 deficiency==
*Also known as Activated phosphoinositide 3-kinase δ syndrome (APDS).
*Also known as activated phosphoinositide 3-kinase δ syndrome (APDS).
*[[Autosomal dominant]] gain of function (GOF) mutation of PIK3CD gene, which encodes for P110δ subunit of [[phosphoinositide 3-kinase]] (PI3K) and loss of function (LOF) mutation of PIK3R1 gene, which encodes the p85α subunit of [[Phosphoinositide 3-kinase|PI3K.]]
*[[Autosomal dominant]] gain of function (GOF) mutation of PIK3CD gene, which encodes for P110δ subunit of [[phosphoinositide 3-kinase]] (PI3K) and loss of function (LOF) mutation of PIK3R1 gene, which encodes the p85α subunit of [[Phosphoinositide 3-kinase|PI3K.]]
*Mutations in PIK3CD gene leads to clinical features similar to  mutation in PIK3R1 gene.<ref name="pmid25546742">{{cite journal |vauthors=Ochs HD |title=Common variable immunodeficiency (CVID): new genetic insight and unanswered questions |journal=Clin. Exp. Immunol. |volume=178 Suppl 1 |issue= |pages=5–6 |date=December 2014 |pmid=25546742 |pmc=4285471 |doi=10.1111/cei.12491 |url=}}</ref>
*Mutations in PIK3CD gene leads to clinical features similar to  mutation in PIK3R1 gene.<ref name="pmid25546742">{{cite journal |vauthors=Ochs HD |title=Common variable immunodeficiency (CVID): new genetic insight and unanswered questions |journal=Clin. Exp. Immunol. |volume=178 Suppl 1 |issue= |pages=5–6 |date=December 2014 |pmid=25546742 |pmc=4285471 |doi=10.1111/cei.12491 |url=}}</ref>
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*Disease is characterized by low numbers of naive [[T cell|T cells]], but a larger number of senescent effector T cells.
*Disease is characterized by low numbers of naive [[T cell|T cells]], but a larger number of senescent effector T cells.
*Patients present with upper and lower respiratory tract infections, [[lymphadenopathy]], nodular lymphoid hyperplasia, early-onset [[autoimmunity]], [[Cancer|malignancies]] and recurrent viral infections with [[cytomegalovirus]] (CMV) and [[Epstein Barr virus]] (EBV).<ref name="pmid24165795">{{cite journal |vauthors=Lucas CL, Kuehn HS, Zhao F, Niemela JE, Deenick EK, Palendira U, Avery DT, Moens L, Cannons JL, Biancalana M, Stoddard J, Ouyang W, Frucht DM, Rao VK, Atkinson TP, Agharahimi A, Hussey AA, Folio LR, Olivier KN, Fleisher TA, Pittaluga S, Holland SM, Cohen JI, Oliveira JB, Tangye SG, Schwartzberg PL, Lenardo MJ, Uzel G |title=Dominant-activating germline mutations in the gene encoding the PI(3)K catalytic subunit p110δ result in T cell senescence and human immunodeficiency |journal=Nat. Immunol. |volume=15 |issue=1 |pages=88–97 |date=January 2014 |pmid=24165795 |pmc=4209962 |doi=10.1038/ni.2771 |url=}}</ref>
*Patients present with upper and lower respiratory tract infections, [[lymphadenopathy]], nodular lymphoid hyperplasia, early-onset [[autoimmunity]], [[Cancer|malignancies]] and recurrent viral infections with [[cytomegalovirus]] (CMV) and [[Epstein Barr virus]] (EBV).<ref name="pmid24165795">{{cite journal |vauthors=Lucas CL, Kuehn HS, Zhao F, Niemela JE, Deenick EK, Palendira U, Avery DT, Moens L, Cannons JL, Biancalana M, Stoddard J, Ouyang W, Frucht DM, Rao VK, Atkinson TP, Agharahimi A, Hussey AA, Folio LR, Olivier KN, Fleisher TA, Pittaluga S, Holland SM, Cohen JI, Oliveira JB, Tangye SG, Schwartzberg PL, Lenardo MJ, Uzel G |title=Dominant-activating germline mutations in the gene encoding the PI(3)K catalytic subunit p110δ result in T cell senescence and human immunodeficiency |journal=Nat. Immunol. |volume=15 |issue=1 |pages=88–97 |date=January 2014 |pmid=24165795 |pmc=4209962 |doi=10.1038/ni.2771 |url=}}</ref>
*Treatment is via [[sirolimus]] and selective PI3Kδ inhibitors, intavenous and subcutaneous [[Antibody|immunoglobulin]] replacement,  prophylactic antibiotic, and hematopoietic stem cell transplant.<ref name="pmid29599784">{{cite journal |vauthors=Maccari ME, Abolhassani H, Aghamohammadi A, Aiuti A, Aleinikova O, Bangs C, Baris S, Barzaghi F, Baxendale H, Buckland M, Burns SO, Cancrini C, Cant A, Cathébras P, Cavazzana M, Chandra A, Conti F, Coulter T, Devlin LA, Edgar JDM, Faust S, Fischer A, Garcia-Prat M, Hammarström L, Heeg M, Jolles S, Karakoc-Aydiner E, Kindle G, Kiykim A, Kumararatne D, Grimbacher B, Longhurst H, Mahlaoui N, Milota T, Moreira F, Moshous D, Mukhina A, Neth O, Neven B, Nieters A, Olbrich P, Ozen A, Pachlopnik Schmid J, Picard C, Prader S, Rae W, Reichenbach J, Rusch S, Savic S, Scarselli A, Scheible R, Sediva A, Sharapova SO, Shcherbina A, Slatter M, Soler-Palacin P, Stanislas A, Suarez F, Tucci F, Uhlmann A, van Montfrans J, Warnatz K, Williams AP, Wood P, Kracker S, Condliffe AM, Ehl S |title=Disease Evolution and Response to Rapamycin in Activated Phosphoinositide 3-Kinase δ Syndrome: The European Society for Immunodeficiencies-Activated Phosphoinositide 3-Kinase δ Syndrome Registry |journal=Front Immunol |volume=9 |issue= |pages=543 |date=2018 |pmid=29599784 |pmc=5863269 |doi=10.3389/fimmu.2018.00543 |url=}}</ref>
*Treatment is via [[sirolimus]] and selective PI3Kδ inhibitors, intavenous and subcutaneous [[Antibody|immunoglobulin]] replacement,  prophylactic antibiotic, and [[Hematopoietic stem cell transplantation|hematopoietic stem cell transplant]].<ref name="pmid29599784">{{cite journal |vauthors=Maccari ME, Abolhassani H, Aghamohammadi A, Aiuti A, Aleinikova O, Bangs C, Baris S, Barzaghi F, Baxendale H, Buckland M, Burns SO, Cancrini C, Cant A, Cathébras P, Cavazzana M, Chandra A, Conti F, Coulter T, Devlin LA, Edgar JDM, Faust S, Fischer A, Garcia-Prat M, Hammarström L, Heeg M, Jolles S, Karakoc-Aydiner E, Kindle G, Kiykim A, Kumararatne D, Grimbacher B, Longhurst H, Mahlaoui N, Milota T, Moreira F, Moshous D, Mukhina A, Neth O, Neven B, Nieters A, Olbrich P, Ozen A, Pachlopnik Schmid J, Picard C, Prader S, Rae W, Reichenbach J, Rusch S, Savic S, Scarselli A, Scheible R, Sediva A, Sharapova SO, Shcherbina A, Slatter M, Soler-Palacin P, Stanislas A, Suarez F, Tucci F, Uhlmann A, van Montfrans J, Warnatz K, Williams AP, Wood P, Kracker S, Condliffe AM, Ehl S |title=Disease Evolution and Response to Rapamycin in Activated Phosphoinositide 3-Kinase δ Syndrome: The European Society for Immunodeficiencies-Activated Phosphoinositide 3-Kinase δ Syndrome Registry |journal=Front Immunol |volume=9 |issue= |pages=543 |date=2018 |pmid=29599784 |pmc=5863269 |doi=10.3389/fimmu.2018.00543 |url=}}</ref>


==PTEN deficiency==
==PTEN deficiency==
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==CD 81 Deficiency==
==CD 81 Deficiency==
*CD81 is a B cell surface protein (part of [[CD19]] complex) which helps in [[antigen]] recognition.  
*CD81 is a B cell surface protein (part of [[CD19]] complex) which helps in [[antigen]] recognition.  
*Deficiency is characterized by decreased in number of [[B cell]], hypogammaglobulinemia , impaired [[antibody]] responses, and absence of [[CD19]] expression on [[B cell|B cells]].
*Deficiency is characterized by decreased in number of [[B cell]], [[hypogammaglobulinemia]] , impaired [[antibody]] responses, and absence of [[CD19]] expression on [[B cell|B cells]].
*Patients present with recurrent  infections of upper and lower respiratory tract.
*Patients present with recurrent  infections of upper and lower respiratory tract.
*Treatment is mainly through replacement of [[immunoglobulins]] by intravenous or subcutaneous routes, hematopoietic stem cell therapy and use of prophylactic and curative antibiotics.<ref name="pmid20237408">{{cite journal |vauthors=van Zelm MC, Smet J, Adams B, Mascart F, Schandené L, Janssen F, Ferster A, Kuo CC, Levy S, van Dongen JJ, van der Burg M |title=CD81 gene defect in humans disrupts CD19 complex formation and leads to antibody deficiency |journal=J. Clin. Invest. |volume=120 |issue=4 |pages=1265–74 |date=April 2010 |pmid=20237408 |pmc=2846042 |doi=10.1172/JCI39748 |url=}}</ref>
*Treatment is mainly through replacement of [[immunoglobulins]] by intravenous or subcutaneous routes, [[Hematopoietic stem cell transplantation|hematopoietic stem cell therapy]] and use of prophylactic and curative [[Antibiotic|antibiotics]].<ref name="pmid20237408">{{cite journal |vauthors=van Zelm MC, Smet J, Adams B, Mascart F, Schandené L, Janssen F, Ferster A, Kuo CC, Levy S, van Dongen JJ, van der Burg M |title=CD81 gene defect in humans disrupts CD19 complex formation and leads to antibody deficiency |journal=J. Clin. Invest. |volume=120 |issue=4 |pages=1265–74 |date=April 2010 |pmid=20237408 |pmc=2846042 |doi=10.1172/JCI39748 |url=}}</ref>


==TACI Deficiency==
==TACI Deficiency==
*Transmembrane activator and calcium-modulator and cyclophilin ligand interactor (TACI) is a part of tumor necrosis factor family and involved in B cell class switching.
*Transmembrane activator and calcium-modulator and cyclophilin ligand interactor ([[TACI]]) is a part of tumor necrosis factor family and involved in B cell class switching.
*Missense mutation of one allele of TNFRSF13B gene encoding for TACI leads to CVID like immunodeficiency.<ref name="pmid16007086">{{cite journal |vauthors=Castigli E, Wilson SA, Garibyan L, Rachid R, Bonilla F, Schneider L, Geha RS |title=TACI is mutant in common variable immunodeficiency and IgA deficiency |journal=Nat. Genet. |volume=37 |issue=8 |pages=829–34 |date=August 2005 |pmid=16007086 |doi=10.1038/ng1601 |url=}}</ref>
*Missense mutation of one [[allele]] of [[TNFRSF13B]] gene encoding for TACI leads to [[Common variable immunodeficiency|CVID]] like immunodeficiency.<ref name="pmid16007086">{{cite journal |vauthors=Castigli E, Wilson SA, Garibyan L, Rachid R, Bonilla F, Schneider L, Geha RS |title=TACI is mutant in common variable immunodeficiency and IgA deficiency |journal=Nat. Genet. |volume=37 |issue=8 |pages=829–34 |date=August 2005 |pmid=16007086 |doi=10.1038/ng1601 |url=}}</ref>
*Patients present with increased suseptability to encapsulated organisms, autoimmunity, and hypogammaglobulinemia.<ref name="pmid21984806">{{cite journal |vauthors=Tsuji S, Cortesão C, Bram RJ, Platt JL, Cascalho M |title=TACI deficiency impairs sustained Blimp-1 expression in B cells decreasing long-lived plasma cells in the bone marrow |journal=Blood |volume=118 |issue=22 |pages=5832–9 |date=November 2011 |pmid=21984806 |pmc=3228499 |doi=10.1182/blood-2011-05-353961 |url=}}</ref><ref name="pmid23237420">{{cite journal |vauthors=Martinez-Gallo M, Radigan L, Almejún MB, Martínez-Pomar N, Matamoros N, Cunningham-Rundles C |title=TACI mutations and impaired B-cell function in subjects with CVID and healthy heterozygotes |journal=J. Allergy Clin. Immunol. |volume=131 |issue=2 |pages=468–76 |date=February 2013 |pmid=23237420 |pmc=3646641 |doi=10.1016/j.jaci.2012.10.029 |url=}}</ref>
*Patients present with increased susceptibility to encapsulated organisms, [[autoimmunity]], and [[hypogammaglobulinemia]].<ref name="pmid21984806">{{cite journal |vauthors=Tsuji S, Cortesão C, Bram RJ, Platt JL, Cascalho M |title=TACI deficiency impairs sustained Blimp-1 expression in B cells decreasing long-lived plasma cells in the bone marrow |journal=Blood |volume=118 |issue=22 |pages=5832–9 |date=November 2011 |pmid=21984806 |pmc=3228499 |doi=10.1182/blood-2011-05-353961 |url=}}</ref><ref name="pmid23237420">{{cite journal |vauthors=Martinez-Gallo M, Radigan L, Almejún MB, Martínez-Pomar N, Matamoros N, Cunningham-Rundles C |title=TACI mutations and impaired B-cell function in subjects with CVID and healthy heterozygotes |journal=J. Allergy Clin. Immunol. |volume=131 |issue=2 |pages=468–76 |date=February 2013 |pmid=23237420 |pmc=3646641 |doi=10.1016/j.jaci.2012.10.029 |url=}}</ref>
*Treatment is by intravenous or subcutaneous replacement of [[Antibody|immunoglobulins]].<ref name="pmid23859429">{{cite journal |vauthors=Ameratunga R, Woon ST, Gillis D, Koopmans W, Steele R |title=New diagnostic criteria for common variable immune deficiency (CVID), which may assist with decisions to treat with intravenous or subcutaneous immunoglobulin |journal=Clin. Exp. Immunol. |volume=174 |issue=2 |pages=203–11 |date=November 2013 |pmid=23859429 |pmc=3828823 |doi=10.1111/cei.12178 |url=}}</ref>
*Treatment is by intravenous or subcutaneous replacement of [[Antibody|immunoglobulins]].<ref name="pmid23859429">{{cite journal |vauthors=Ameratunga R, Woon ST, Gillis D, Koopmans W, Steele R |title=New diagnostic criteria for common variable immune deficiency (CVID), which may assist with decisions to treat with intravenous or subcutaneous immunoglobulin |journal=Clin. Exp. Immunol. |volume=174 |issue=2 |pages=203–11 |date=November 2013 |pmid=23859429 |pmc=3828823 |doi=10.1111/cei.12178 |url=}}</ref>


==BAFF Receptor Deficiency==
==BAFF Receptor Deficiency==
*Mutation of B-cell activating factor receptor (BAFF-R) prevents maturation of transitional B cell, leading to a CVID type adult onset immunodeficiency.
*Mutation of B-cell activating factor receptor (BAFF-R) prevents maturation of transitional B cell, leading to a CVID type adult onset immunodeficiency.
*Incomplete maturation leads to hypogammaglobulinemia, but can in a few cases not manifest to clinical disease, with recurrent infections.
*Incomplete maturation leads to [[hypogammaglobulinemia]], but can in a few cases not manifest to clinical disease, with recurrent infections.
*Patients show varying degrees immunodeficiency but normal IgA levels.<ref name="pmid19666484">{{cite journal |vauthors=Warnatz K, Salzer U, Rizzi M, Fischer B, Gutenberger S, Böhm J, Kienzler AK, Pan-Hammarström Q, Hammarström L, Rakhmanov M, Schlesier M, Grimbacher B, Peter HH, Eibel H |title=B-cell activating factor receptor deficiency is associated with an adult-onset antibody deficiency syndrome in humans |journal=Proc. Natl. Acad. Sci. U.S.A. |volume=106 |issue=33 |pages=13945–50 |date=August 2009 |pmid=19666484 |pmc=2722504 |doi=10.1073/pnas.0903543106 |url=}}</ref><ref name="pmid349534">{{cite journal |vauthors=Woolf N |title=The origins of atherosclerosis |journal=Postgrad Med J |volume=54 |issue=629 |pages=156–62 |date=March 1978 |pmid=349534 |pmc=2425199 |doi= |url=}}</ref>
*Patients show varying degrees [[immunodeficiency]] but normal [[Immunoglobulin A|IgA]] levels.<ref name="pmid19666484">{{cite journal |vauthors=Warnatz K, Salzer U, Rizzi M, Fischer B, Gutenberger S, Böhm J, Kienzler AK, Pan-Hammarström Q, Hammarström L, Rakhmanov M, Schlesier M, Grimbacher B, Peter HH, Eibel H |title=B-cell activating factor receptor deficiency is associated with an adult-onset antibody deficiency syndrome in humans |journal=Proc. Natl. Acad. Sci. U.S.A. |volume=106 |issue=33 |pages=13945–50 |date=August 2009 |pmid=19666484 |pmc=2722504 |doi=10.1073/pnas.0903543106 |url=}}</ref><ref name="pmid349534">{{cite journal |vauthors=Woolf N |title=The origins of atherosclerosis |journal=Postgrad Med J |volume=54 |issue=629 |pages=156–62 |date=March 1978 |pmid=349534 |pmc=2425199 |doi= |url=}}</ref>
*Treatment is by intravenous or subcutaneous replacement of [[Antibody|immunoglobulins]] and by curative [[antibiotics]].<ref name="pmid23859429">{{cite journal |vauthors=Ameratunga R, Woon ST, Gillis D, Koopmans W, Steele R |title=New diagnostic criteria for common variable immune deficiency (CVID), which may assist with decisions to treat with intravenous or subcutaneous immunoglobulin |journal=Clin. Exp. Immunol. |volume=174 |issue=2 |pages=203–11 |date=November 2013 |pmid=23859429 |pmc=3828823 |doi=10.1111/cei.12178 |url=}}</ref>
*Treatment is by intravenous or subcutaneous replacement of [[Antibody|immunoglobulins]] and by curative [[antibiotics]].<ref name="pmid23859429">{{cite journal |vauthors=Ameratunga R, Woon ST, Gillis D, Koopmans W, Steele R |title=New diagnostic criteria for common variable immune deficiency (CVID), which may assist with decisions to treat with intravenous or subcutaneous immunoglobulin |journal=Clin. Exp. Immunol. |volume=174 |issue=2 |pages=203–11 |date=November 2013 |pmid=23859429 |pmc=3828823 |doi=10.1111/cei.12178 |url=}}</ref>


==TWEAK Deficiency==
==TWEAK Deficiency==
*[[CVID]] like phenotype caused by, an [[autosomal dominant]] transmitted, deficiency in TNF-like weak inducer of apoptosis (TWEAK).
*[[CVID]] like phenotype caused by, an [[autosomal dominant]] transmitted, deficiency in TNF-like weak inducer of apoptosis (TWEAK).
*Mutation in TWEAK is associated with regulation of BAFF associated [[B cell]] development leading to impared B cell survival and isotype class switching.
*Mutation in TWEAK is associated with regulation of [[BAFF receptor|BAFF]] associated [[B cell]] development leading to impaired B cell survival and [[Immunoglobulin class switching|isotype class switching]].
*[[Disease]] is characterized by recurrent infection and impaired response to [[vaccine|vaccination]].<ref name="pmid23493554">{{cite journal |vauthors=Wang HY, Ma CA, Zhao Y, Fan X, Zhou Q, Edmonds P, Uzel G, Oliveira JB, Orange J, Jain A |title=Antibody deficiency associated with an inherited autosomal dominant mutation in TWEAK |journal=Proc. Natl. Acad. Sci. U.S.A. |volume=110 |issue=13 |pages=5127–32 |date=March 2013 |pmid=23493554 |pmc=3612633 |doi=10.1073/pnas.1221211110 |url=}}</ref>
*[[Disease]] is characterized by recurrent infection and impaired response to [[vaccine|vaccination]].<ref name="pmid23493554">{{cite journal |vauthors=Wang HY, Ma CA, Zhao Y, Fan X, Zhou Q, Edmonds P, Uzel G, Oliveira JB, Orange J, Jain A |title=Antibody deficiency associated with an inherited autosomal dominant mutation in TWEAK |journal=Proc. Natl. Acad. Sci. U.S.A. |volume=110 |issue=13 |pages=5127–32 |date=March 2013 |pmid=23493554 |pmc=3612633 |doi=10.1073/pnas.1221211110 |url=}}</ref>
*Treatment is by intravenous or subcutaneous replacement of [[Antibody|immunoglobulins]] and by curative [[antibiotics]].<ref name="pmid23859429">{{cite journal |vauthors=Ameratunga R, Woon ST, Gillis D, Koopmans W, Steele R |title=New diagnostic criteria for common variable immune deficiency (CVID), which may assist with decisions to treat with intravenous or subcutaneous immunoglobulin |journal=Clin. Exp. Immunol. |volume=174 |issue=2 |pages=203–11 |date=November 2013 |pmid=23859429 |pmc=3828823 |doi=10.1111/cei.12178 |url=}}</ref>
*Treatment is by intravenous or subcutaneous replacement of [[Antibody|immunoglobulins]] and by curative [[antibiotics]].<ref name="pmid23859429">{{cite journal |vauthors=Ameratunga R, Woon ST, Gillis D, Koopmans W, Steele R |title=New diagnostic criteria for common variable immune deficiency (CVID), which may assist with decisions to treat with intravenous or subcutaneous immunoglobulin |journal=Clin. Exp. Immunol. |volume=174 |issue=2 |pages=203–11 |date=November 2013 |pmid=23859429 |pmc=3828823 |doi=10.1111/cei.12178 |url=}}</ref>
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==TTC37 Deficiency==
==TTC37 Deficiency==
*Tetratricopeptide Repeat Domain 37 (TTC37) deficency is an [[autosomal recessive]] disease causing syndromic diarrhea/tricho-hepato-enteric syndrome (SD/THE) which has a similar immune phenotype to CVID.
*Tetratricopeptide Repeat Domain 37 (TTC37) deficency is an [[autosomal recessive]] disease causing syndromic diarrhea/tricho-hepato-enteric syndrome (SD/THE) which has a similar immune phenotype to [[Common variable immunodeficiency|CVID]].
*TTC37 is involved in aberrant mRNAs decay.
*TTC37 is involved in aberrant mRNAs decay.
*Patient presents in infancy with low [[Immunoglobulin G|IgG]] and poor antigen-stimulation to [[vaccine]].
*Patient presents in infancy with low [[Immunoglobulin G|IgG]] and poor antigen-stimulation to [[vaccine]].
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==CD19 Deficiency==
==CD19 Deficiency==
*CD19 surface expression can be absent in cases of homozygous [[CD19]] deficiency or CD81 deficiency.
*[[CD19]] surface expression can be absent in cases of homozygous [[CD19]] deficiency or CD81 deficiency.
*Deficiency leads to impaired formation of [[CD19]] complex and  B cell development and antibody response.<ref name="pmid20445561">{{cite journal |vauthors=Artac H, Reisli I, Kara R, Pico-Knijnenburg I, Adin-Çinar S, Pekcan S, Jol-van der Zijde CM, van Tol MJ, Bakker-Jonges LE, van Dongen JJ, van der Burg M, van Zelm MC |title=B-cell maturation and antibody responses in individuals carrying a mutated CD19 allele |journal=Genes Immun. |volume=11 |issue=7 |pages=523–30 |date=October 2010 |pmid=20445561 |doi=10.1038/gene.2010.22 |url=}}</ref>
*Deficiency leads to impaired formation of [[CD19]] complex and  [[B cell]] development and [[antibody]] response.<ref name="pmid20445561">{{cite journal |vauthors=Artac H, Reisli I, Kara R, Pico-Knijnenburg I, Adin-Çinar S, Pekcan S, Jol-van der Zijde CM, van Tol MJ, Bakker-Jonges LE, van Dongen JJ, van der Burg M, van Zelm MC |title=B-cell maturation and antibody responses in individuals carrying a mutated CD19 allele |journal=Genes Immun. |volume=11 |issue=7 |pages=523–30 |date=October 2010 |pmid=20445561 |doi=10.1038/gene.2010.22 |url=}}</ref>
*Patients show increased susceptibility to infection, [[hypogammaglobulinemia]] and impaired response to vaccines.<ref name="pmid16672701">{{cite journal |vauthors=van Zelm MC, Reisli I, van der Burg M, Castaño D, van Noesel CJ, van Tol MJ, Woellner C, Grimbacher B, Patiño PJ, van Dongen JJ, Franco JL |title=An antibody-deficiency syndrome due to mutations in the CD19 gene |journal=N. Engl. J. Med. |volume=354 |issue=18 |pages=1901–12 |date=May 2006 |pmid=16672701 |doi=10.1056/NEJMoa051568 |url=}}</ref>
*Patients show increased susceptibility to infection, [[hypogammaglobulinemia]] and impaired response to vaccines.<ref name="pmid16672701">{{cite journal |vauthors=van Zelm MC, Reisli I, van der Burg M, Castaño D, van Noesel CJ, van Tol MJ, Woellner C, Grimbacher B, Patiño PJ, van Dongen JJ, Franco JL |title=An antibody-deficiency syndrome due to mutations in the CD19 gene |journal=N. Engl. J. Med. |volume=354 |issue=18 |pages=1901–12 |date=May 2006 |pmid=16672701 |doi=10.1056/NEJMoa051568 |url=}}</ref>
*Treatment is by intravenous or subcutaneous replacement of [[Antibody|immunoglobulins]] and by curative [[antibiotics]].<ref name="pmid23859429">{{cite journal |vauthors=Ameratunga R, Woon ST, Gillis D, Koopmans W, Steele R |title=New diagnostic criteria for common variable immune deficiency (CVID), which may assist with decisions to treat with intravenous or subcutaneous immunoglobulin |journal=Clin. Exp. Immunol. |volume=174 |issue=2 |pages=203–11 |date=November 2013 |pmid=23859429 |pmc=3828823 |doi=10.1111/cei.12178 |url=}}</ref>
*Treatment is by intravenous or subcutaneous replacement of [[Antibody|immunoglobulins]] and by curative [[antibiotics]].<ref name="pmid23859429">{{cite journal |vauthors=Ameratunga R, Woon ST, Gillis D, Koopmans W, Steele R |title=New diagnostic criteria for common variable immune deficiency (CVID), which may assist with decisions to treat with intravenous or subcutaneous immunoglobulin |journal=Clin. Exp. Immunol. |volume=174 |issue=2 |pages=203–11 |date=November 2013 |pmid=23859429 |pmc=3828823 |doi=10.1111/cei.12178 |url=}}</ref>


==CD20 Deficiency==
==CD20 Deficiency==
*CD20 is essential for [[T cell]] independent antibody response.  
*[[CD20]] is essential for [[T cell]] independent antibody response.  
*Deficiency of CD20 therefore leads to reduced ability to mount an antibody response.
*Deficiency of [[CD20]] therefore leads to reduced ability to mount an antibody response.
*Patients have increased risk of infections by encapsulated bacteria, [[hypogammaglobulinemia]], due to decrease [[somatic hypermutation]], and normal B cell numbers; but a decrease in number of circulating memory [[B cell|B cells]].<ref name="pmid20038800">{{cite journal |vauthors=Kuijpers TW, Bende RJ, Baars PA, Grummels A, Derks IA, Dolman KM, Beaumont T, Tedder TF, van Noesel CJ, Eldering E, van Lier RA |title=CD20 deficiency in humans results in impaired T cell-independent antibody responses |journal=J. Clin. Invest. |volume=120 |issue=1 |pages=214–22 |date=January 2010 |pmid=20038800 |pmc=2798692 |doi=10.1172/JCI40231 |url=}}</ref>
*Patients have increased risk of infections by encapsulated bacteria, [[hypogammaglobulinemia]], due to decrease [[somatic hypermutation]], and normal B cell numbers; but a decrease in number of circulating memory [[B cell|B cells]].<ref name="pmid20038800">{{cite journal |vauthors=Kuijpers TW, Bende RJ, Baars PA, Grummels A, Derks IA, Dolman KM, Beaumont T, Tedder TF, van Noesel CJ, Eldering E, van Lier RA |title=CD20 deficiency in humans results in impaired T cell-independent antibody responses |journal=J. Clin. Invest. |volume=120 |issue=1 |pages=214–22 |date=January 2010 |pmid=20038800 |pmc=2798692 |doi=10.1172/JCI40231 |url=}}</ref>
*Treatment is by intravenous or subcutaneous replacement of [[Antibody|immunoglobulins]] and by curative [[antibiotics]].<ref name="pmid23859429">{{cite journal |vauthors=Ameratunga R, Woon ST, Gillis D, Koopmans W, Steele R |title=New diagnostic criteria for common variable immune deficiency (CVID), which may assist with decisions to treat with intravenous or subcutaneous immunoglobulin |journal=Clin. Exp. Immunol. |volume=174 |issue=2 |pages=203–11 |date=November 2013 |pmid=23859429 |pmc=3828823 |doi=10.1111/cei.12178 |url=}}</ref>
*Treatment is by intravenous or subcutaneous replacement of [[Antibody|immunoglobulins]] and by curative [[antibiotics]].<ref name="pmid23859429">{{cite journal |vauthors=Ameratunga R, Woon ST, Gillis D, Koopmans W, Steele R |title=New diagnostic criteria for common variable immune deficiency (CVID), which may assist with decisions to treat with intravenous or subcutaneous immunoglobulin |journal=Clin. Exp. Immunol. |volume=174 |issue=2 |pages=203–11 |date=November 2013 |pmid=23859429 |pmc=3828823 |doi=10.1111/cei.12178 |url=}}</ref>
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==CD21 Deficiency==
==CD21 Deficiency==
*CD21 is a receptor for complement C3d which helps in antigen specific response.
*CD21 is a receptor for complement C3d which helps in antigen specific response.
*Patients present with increased susceptibility to infections, decreased [[immunoglobulin]] class switching, chronic diarrhea and hypogammaglobulinemia.
*Patients present with increased susceptibility to infections, decreased [[immunoglobulin class switching]], chronic [[diarrhea]] and [[hypogammaglobulinemia]].
*Unlike patients with [[CD19]] and [[CD20]] deficiency patients with CD 21 have less sever clinical phenotype, and are able to mount specific [[antibody]] response to [[Vaccine|vaccines]] but not very well with polysaccharide vaccines.<ref name="pmid22035880">{{cite journal |vauthors=Thiel J, Kimmig L, Salzer U, Grudzien M, Lebrecht D, Hagena T, Draeger R, Voelxen N, Völxen N, Bergbreiter A, Jennings S, Gutenberger S, Aichem A, Illges H, Hannan JP, Kienzler AK, Rizzi M, Eibel H, Peter HH, Warnatz K, Grimbacher B, Rump JA, Schlesier M |title Genetic CD21 deficiency is associated with hypogammaglobulinemia |journal=J. Allergy Clin. Immunol. |volume=129 |issue=3 |pages=801–810.e6 |date=March 2012 |pmid=22035880 |doi=10.1016/j.jaci.2011.09.027 |url=}}</ref>
*Unlike patients with [[CD19]] and [[CD20]] deficiency patients with CD 21 have less sever clinical phenotype, and are able to mount specific [[antibody]] response to [[Vaccine|vaccines]] but not very well with polysaccharide [[Vaccine|vaccines]].<ref name="pmid22035880">{{cite journal |vauthors=Thiel J, Kimmig L, Salzer U, Grudzien M, Lebrecht D, Hagena T, Draeger R, Voelxen N, Völxen N, Bergbreiter A, Jennings S, Gutenberger S, Aichem A, Illges H, Hannan JP, Kienzler AK, Rizzi M, Eibel H, Peter HH, Warnatz K, Grimbacher B, Rump JA, Schlesier M |title Genetic CD21 deficiency is associated with hypogammaglobulinemia |journal=J. Allergy Clin. Immunol. |volume=129 |issue=3 |pages=801–810.e6 |date=March 2012 |pmid=22035880 |doi=10.1016/j.jaci.2011.09.027 |url=}}</ref>
*Treatment is by curative [[antibiotics]] to treat recurrent infections.<ref name="pmid23859429">{{cite journal |vauthors=Ameratunga R, Woon ST, Gillis D, Koopmans W, Steele R |title=New diagnostic criteria for common variable immune deficiency (CVID), which may assist with decisions to treat with intravenous or subcutaneous immunoglobulin |journal=Clin. Exp. Immunol. |volume=174 |issue=2 |pages=203–11 |date=November 2013 |pmid=23859429 |pmc=3828823 |doi=10.1111/cei.12178 |url=}}</ref>
*Treatment is by curative [[antibiotics]] to treat recurrent infections.<ref name="pmid23859429">{{cite journal |vauthors=Ameratunga R, Woon ST, Gillis D, Koopmans W, Steele R |title=New diagnostic criteria for common variable immune deficiency (CVID), which may assist with decisions to treat with intravenous or subcutaneous immunoglobulin |journal=Clin. Exp. Immunol. |volume=174 |issue=2 |pages=203–11 |date=November 2013 |pmid=23859429 |pmc=3828823 |doi=10.1111/cei.12178 |url=}}</ref>


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*It leads to a childhood syndromic form of congenital [[sideroblastic anemia]] (CSA) associated with [[Humoral immune deficiency|B-cell immunodeficiency]], periodic fevers, and [[Developmental disability|developmental delay]] (SIFD).
*It leads to a childhood syndromic form of congenital [[sideroblastic anemia]] (CSA) associated with [[Humoral immune deficiency|B-cell immunodeficiency]], periodic fevers, and [[Developmental disability|developmental delay]] (SIFD).
*Disease is characterized by childhood developmental delay, [[neurodegeneration]], [[Seizure|seizures]], [[Sensorineural hearing loss|sensorineural deafness]], and other multi organ anomalies.
*Disease is characterized by childhood developmental delay, [[neurodegeneration]], [[Seizure|seizures]], [[Sensorineural hearing loss|sensorineural deafness]], and other multi organ anomalies.
*Treatment is by intravenous [[Antibody|immunoglobulin]], transfusion for [[anemia]] and by bone marrow transplantation.<ref name="pmid27370603">{{cite journal |vauthors=Wedatilake Y, Niazi R, Fassone E, Powell CA, Pearce S, Plagnol V, Saldanha JW, Kleta R, Chong WK, Footitt E, Mills PB, Taanman JW, Minczuk M, Clayton PT, Rahman S |title=TRNT1 deficiency: clinical, biochemical and molecular genetic features |journal=Orphanet J Rare Dis |volume=11 |issue=1 |pages=90 |date=July 2016 |pmid=27370603 |pmc=4930608 |doi=10.1186/s13023-016-0477-0 |url=}}</ref><ref name="pmid23553769">{{cite journal |vauthors=Wiseman DH, May A, Jolles S, Connor P, Powell C, Heeney MM, Giardina PJ, Klaassen RJ, Chakraborty P, Geraghty MT, Major-Cook N, Kannengiesser C, Thuret I, Thompson AA, Marques L, Hughes S, Bonney DK, Bottomley SS, Fleming MD, Wynn RF |title=A novel syndrome of congenital sideroblastic anemia, B-cell immunodeficiency, periodic fevers, and developmental delay (SIFD) |journal=Blood |volume=122 |issue=1 |pages=112–23 |date=July 2013 |pmid=23553769 |pmc=3761334 |doi=10.1182/blood-2012-08-439083 |url=}}</ref>
*Treatment is by intravenous [[Antibody|immunoglobulin]], transfusion for [[anemia]] and by [[bone marrow transplantation]].<ref name="pmid27370603">{{cite journal |vauthors=Wedatilake Y, Niazi R, Fassone E, Powell CA, Pearce S, Plagnol V, Saldanha JW, Kleta R, Chong WK, Footitt E, Mills PB, Taanman JW, Minczuk M, Clayton PT, Rahman S |title=TRNT1 deficiency: clinical, biochemical and molecular genetic features |journal=Orphanet J Rare Dis |volume=11 |issue=1 |pages=90 |date=July 2016 |pmid=27370603 |pmc=4930608 |doi=10.1186/s13023-016-0477-0 |url=}}</ref><ref name="pmid23553769">{{cite journal |vauthors=Wiseman DH, May A, Jolles S, Connor P, Powell C, Heeney MM, Giardina PJ, Klaassen RJ, Chakraborty P, Geraghty MT, Major-Cook N, Kannengiesser C, Thuret I, Thompson AA, Marques L, Hughes S, Bonney DK, Bottomley SS, Fleming MD, Wynn RF |title=A novel syndrome of congenital sideroblastic anemia, B-cell immunodeficiency, periodic fevers, and developmental delay (SIFD) |journal=Blood |volume=122 |issue=1 |pages=112–23 |date=July 2013 |pmid=23553769 |pmc=3761334 |doi=10.1182/blood-2012-08-439083 |url=}}</ref>


==NFKB1 Deficiency==
==NFKB1 Deficiency==
*Nuclear factor κB subunit 1 ([[NFKB1]]) plays an important role in [[B cell]] differentiation and function.
*[[NFKB1|Nuclear factor κB subunit 1]] ([[NFKB1]]) plays an important role in [[B cell]] differentiation and function.
*NFKB1 is essential for [[Antibody|immunoglobulin]] [[Immunoglobulin class switching|class switching]] and deficiency can lead to an hyper-IgM like syndrome with lower [[Immunoglobulin G|IgG]] and [[Immunoglobulin A|IgA]] production.<ref name="pmid11224521">{{cite journal |vauthors=Jain A, Ma CA, Liu S, Brown M, Cohen J, Strober W |title=Specific missense mutations in NEMO result in hyper-IgM syndrome with hypohydrotic ectodermal dysplasia |journal=Nat. Immunol. |volume=2 |issue=3 |pages=223–8 |date=March 2001 |pmid=11224521 |doi=10.1038/85277 |url=}}</ref>
*[[NFKB1]] is essential for [[Antibody|immunoglobulin]] [[Immunoglobulin class switching|class switching]] and deficiency can lead to an hyper-IgM like syndrome with lower [[Immunoglobulin G|IgG]] and [[Immunoglobulin A|IgA]] production.<ref name="pmid11224521">{{cite journal |vauthors=Jain A, Ma CA, Liu S, Brown M, Cohen J, Strober W |title=Specific missense mutations in NEMO result in hyper-IgM syndrome with hypohydrotic ectodermal dysplasia |journal=Nat. Immunol. |volume=2 |issue=3 |pages=223–8 |date=March 2001 |pmid=11224521 |doi=10.1038/85277 |url=}}</ref>
*Sporadic or familial loss of function mutations of [[NFKB1]] leads to progressive [[Humoral immunity|humoral]] immunodeficiency, with a highly variable clinical spectrum.
*Sporadic or familial loss of function mutations of [[NFKB1]] leads to progressive [[Humoral immunity|humoral]] immunodeficiency, with a highly variable clinical spectrum.
*It is considered the most common known monogenic cause of [[CVID]] .
*It is considered the most common known monogenic cause of [[CVID]] .
Line 234: Line 235:
*Individually usually require lifelong followup.
*Individually usually require lifelong followup.
*Patients are treated with replacement [[Antibody|immunoglobulins]] depending on severity of [[antibody]] deficiency.<ref name="pmid29477724">{{cite journal |vauthors=Tuijnenburg P, Lango Allen H, Burns SO, Greene D, Jansen MH, Staples E, Stephens J, Carss KJ, Biasci D, Baxendale H, Thomas M, Chandra A, Kiani-Alikhan S, Longhurst HJ, Seneviratne SL, Oksenhendler E, Simeoni I, de Bree GJ, Tool ATJ, van Leeuwen EMM, Ebberink EHTM, Meijer AB, Tuna S, Whitehorn D, Brown M, Turro E, Thrasher AJ, Smith KGC, Thaventhiran JE, Kuijpers TW |title=Loss-of-function nuclear factor κB subunit 1 (NFKB1) variants are the most common monogenic cause of common variable immunodeficiency in Europeans |journal=J. Allergy Clin. Immunol. |volume=142 |issue=4 |pages=1285–1296 |date=October 2018 |pmid=29477724 |pmc=6148345 |doi=10.1016/j.jaci.2018.01.039 |url=}}</ref><ref name="pmid26279205">{{cite journal |vauthors=Fliegauf M, Bryant VL, Frede N, Slade C, Woon ST, Lehnert K, Winzer S, Bulashevska A, Scerri T, Leung E, Jordan A, Keller B, de Vries E, Cao H, Yang F, Schäffer AA, Warnatz K, Browett P, Douglass J, Ameratunga RV, van der Meer JW, Grimbacher B |title=Haploinsufficiency of the NF-κB1 Subunit p50 in Common Variable Immunodeficiency |journal=Am. J. Hum. Genet. |volume=97 |issue=3 |pages=389–403 |date=September 2015 |pmid=26279205 |pmc=4564940 |doi=10.1016/j.ajhg.2015.07.008 |url=}}</ref>
*Patients are treated with replacement [[Antibody|immunoglobulins]] depending on severity of [[antibody]] deficiency.<ref name="pmid29477724">{{cite journal |vauthors=Tuijnenburg P, Lango Allen H, Burns SO, Greene D, Jansen MH, Staples E, Stephens J, Carss KJ, Biasci D, Baxendale H, Thomas M, Chandra A, Kiani-Alikhan S, Longhurst HJ, Seneviratne SL, Oksenhendler E, Simeoni I, de Bree GJ, Tool ATJ, van Leeuwen EMM, Ebberink EHTM, Meijer AB, Tuna S, Whitehorn D, Brown M, Turro E, Thrasher AJ, Smith KGC, Thaventhiran JE, Kuijpers TW |title=Loss-of-function nuclear factor κB subunit 1 (NFKB1) variants are the most common monogenic cause of common variable immunodeficiency in Europeans |journal=J. Allergy Clin. Immunol. |volume=142 |issue=4 |pages=1285–1296 |date=October 2018 |pmid=29477724 |pmc=6148345 |doi=10.1016/j.jaci.2018.01.039 |url=}}</ref><ref name="pmid26279205">{{cite journal |vauthors=Fliegauf M, Bryant VL, Frede N, Slade C, Woon ST, Lehnert K, Winzer S, Bulashevska A, Scerri T, Leung E, Jordan A, Keller B, de Vries E, Cao H, Yang F, Schäffer AA, Warnatz K, Browett P, Douglass J, Ameratunga RV, van der Meer JW, Grimbacher B |title=Haploinsufficiency of the NF-κB1 Subunit p50 in Common Variable Immunodeficiency |journal=Am. J. Hum. Genet. |volume=97 |issue=3 |pages=389–403 |date=September 2015 |pmid=26279205 |pmc=4564940 |doi=10.1016/j.ajhg.2015.07.008 |url=}}</ref>
==NFKB2 Deficiency==
*[[NFKB2|Nuclear factor kappa-B subunit 2]] ([[NFKB2]]) is a part of noncolonical [[NF-κB]] pathway and is involved in B cell maturation and [[antibody]] development.<ref name="pmid24140114">{{cite journal |vauthors=Chen K, Coonrod EM, Kumánovics A, Franks ZF, Durtschi JD, Margraf RL, Wu W, Heikal NM, Augustine NH, Ridge PG, Hill HR, Jorde LB, Weyrich AS, Zimmerman GA, Gundlapalli AV, Bohnsack JF, Voelkerding KV |title=Germline mutations in NFKB2 implicate the noncanonical NF-κB pathway in the pathogenesis of common variable immunodeficiency |journal=Am. J. Hum. Genet. |volume=93 |issue=5 |pages=812–24 |date=November 2013 |pmid=24140114 |pmc=3824125 |doi=10.1016/j.ajhg.2013.09.009 |url=}}</ref>
*Mutations leading to deficiency cause [[Common variable immunodeficiency|CVID]] with  early onset [[Adrenocorticotropic hormone deficiency|central adrenal insufficiency]] and at times [[ectodermal dysplasia]].
*Patients presents with [[Adrenocorticotropic hormone deficiency|ACTH deficiency]], recurrent infections, [[hypogammaglobulinemia]], decreased response to [[Vaccine|vaccines]] and [[autoimmunity]] effecting the skin, hair, and nails
*Treatment is via [[immunoglobulin]] replacement therapy and [[glucocorticoid]] replacement.<ref name="pmid27749582">{{cite journal |vauthors=Shi C, Wang F, Tong A, Zhang XQ, Song HM, Liu ZY, Lyu W, Liu YH, Xia WB |title=NFKB2 mutation in common variable immunodeficiency and isolated adrenocorticotropic hormone deficiency: A case report and review of literature |journal=Medicine (Baltimore) |volume=95 |issue=40 |pages=e5081 |date=October 2016 |pmid=27749582 |pmc=5059085 |doi=10.1097/MD.0000000000005081 |url=}}</ref>
==IKAROS Deficiency==
*IKAROS gene encodes for a family of hemopoietic-specific zinc finger proteins which are essential for [[lymphocyte]] development.<ref name="pmid9143685">{{cite journal |vauthors=Georgopoulos K, Winandy S, Avitahl N |title=The role of the Ikaros gene in lymphocyte development and homeostasis |journal=Annu. Rev. Immunol. |volume=15 |issue= |pages=155–76 |date=1997 |pmid=9143685 |doi=10.1146/annurev.immunol.15.1.155 |url=}}</ref>
*Individuals show varied severity of clinical disease, despite most patients having low [[B cell]] and [[antibody]] count.
*Deficiency leads to [[hypogammaglobulinemia]], decreased response to vaccines, recurrent bacterial infections and [[Cancer|malignancies]].
*Treatment is via replacement of [[immunoglobulins]] and  treatment of infections with [[Antibiotic|antibiotics]].<ref name="pmid26981933">{{cite journal |vauthors=Kuehn HS, Boisson B, Cunningham-Rundles C, Reichenbach J, Stray-Pedersen A, Gelfand EW, Maffucci P, Pierce KR, Abbott JK, Voelkerding KV, South ST, Augustine NH, Bush JS, Dolen WK, Wray BB, Itan Y, Cobat A, Sorte HS, Ganesan S, Prader S, Martins TB, Lawrence MG, Orange JS, Calvo KR, Niemela JE, Casanova JL, Fleisher TA, Hill HR, Kumánovics A, Conley ME, Rosenzweig SD |title=Loss of B Cells in Patients with Heterozygous Mutations in IKAROS |journal=N. Engl. J. Med. |volume=374 |issue=11 |pages=1032–1043 |date=March 2016 |pmid=26981933 |pmc=4836293 |doi=10.1056/NEJMoa1512234 |url=}}</ref>
==ATP6AP1 Deficiency==
*[[ATP6AP1]] encodes for Ac45 of human [[V-ATPase]] and is homologus to yeast [[V-ATPase]] assembly factor Voa1.
*This gene is involved in [[B cell]] functioning, [[antigen]] recognition and [[antibody]] production.<ref name="pmid26579118">{{cite journal |vauthors=Lou Z, Casali P, Xu Z |title=Regulation of B Cell Differentiation by Intracellular Membrane-Associated Proteins and microRNAs: Role in the Antibody Response |journal=Front Immunol |volume=6 |issue= |pages=537 |date=2015 |pmid=26579118 |pmc=4620719 |doi=10.3389/fimmu.2015.00537 |url=}}</ref>
*Deficiency therefore leads to [[hypogammaglobulinemia]] and increased susceptibility to infections.
*Deficiency leads to pathology in the liver (ranging from [[cirrhosis]] to [[Liver disease|end-stage liver failure]]), [[leukopenia]] , and low levels of [[copper]] and [[ceruloplasmin]], and high [[alkaline phosphatase]].
*Patients are treated with [[IVIG|intravenous immunoglobulins]].<ref name="pmid27231034">{{cite journal |vauthors=Jansen EJ, Timal S, Ryan M, Ashikov A, van Scherpenzeel M, Graham LA, Mandel H, Hoischen A, Iancu TC, Raymond K, Steenbergen G, Gilissen C, Huijben K, van Bakel NH, Maeda Y, Rodenburg RJ, Adamowicz M, Crushell E, Koenen H, Adams D, Vodopiutz J, Greber-Platzer S, Müller T, Dueckers G, Morava E, Sykut-Cegielska J, Martens GJ, Wevers RA, Niehues T, Huynen MA, Veltman JA, Stevens TH, Lefeber DJ |title=ATP6AP1 deficiency causes an immunodeficiency with hepatopathy, cognitive impairment and abnormal protein glycosylation |journal=Nat Commun |volume=7 |issue= |pages=11600 |date=May 2016 |pmid=27231034 |pmc=4894975 |doi=10.1038/ncomms11600 |url=}}</ref>
==AID Deficiency==
*[[Activation-induced cytidine deaminase]] (AID) is expressed by [[germinal center]] B cells and plays a crucial role in [[B cell]] terminal differentiation and antibody response (somatic hypermutation and class switching).
*Deficiency leads to a form of the [[Hyper IgM syndrome|hyper-IgM syndrome]] (HIGM2), which shows [[autosomal recessive]] inheritance.
*Disease is characterized by loss of [[immunoglobulin class switching]] and [[somatic hypermutation]], as well as [[lymphoid]] [[hyperplasia]] with giant [[Germinal center|germinal centers]] and enlarged [[Lymph node|lymph nodes]] requiring frequent biopsies.<ref name="pmid11007475">{{cite journal |vauthors=Revy P, Muto T, Levy Y, Geissmann F, Plebani A, Sanal O, Catalan N, Forveille M, Dufourcq-Labelouse R, Gennery A, Tezcan I, Ersoy F, Kayserili H, Ugazio AG, Brousse N, Muramatsu M, Notarangelo LD, Kinoshita K, Honjo T, Fischer A, Durandy A |title=Activation-induced cytidine deaminase (AID) deficiency causes the autosomal recessive form of the Hyper-IgM syndrome (HIGM2) |journal=Cell |volume=102 |issue=5 |pages=565–75 |date=September 2000 |pmid=11007475 |doi= |url=}}</ref>
*Patients typically have normal or increased [[Immunoglobulin M|IgM]], but lack [[Immunoglobulin G|IgG]] and [[Immunoglobulin A|IgA]].
*Immunodeficiency is complicated by [[Autoimmunity|autoimmune disorders]], gastric illnesses due to impaired [[Immunoglobulin A|IgA]] production, and recurrent bacterial infections of the upper respiratory system.
*Treatment is via replacement of [[immunoglobulins]], [[Corticosteroid|corticosteroids]] for [[autoimmunity]].<ref name="pmid23215867">{{cite journal |vauthors=Durandy A, Cantaert T, Kracker S, Meffre E |title=Potential roles of activation-induced cytidine deaminase in promotion or prevention of autoimmunity in humans |journal=Autoimmunity |volume=46 |issue=2 |pages=148–56 |date=March 2013 |pmid=23215867 |pmc=4077434 |doi=10.3109/08916934.2012.750299 |url=}}</ref><ref name="pmid18716662">{{cite journal |vauthors=Hase K, Takahashi D, Ebisawa M, Kawano S, Itoh K, Ohno H |title=Activation-induced cytidine deaminase deficiency causes organ-specific autoimmune disease |journal=PLoS ONE |volume=3 |issue=8 |pages=e3033 |date=August 2008 |pmid=18716662 |pmc=2515643 |doi=10.1371/journal.pone.0003033 |url=}}</ref>
==UNG deficiency==
*Uracil-N glycosylase (UNG) removes uracil in [[DNA]] plays a role in suppressing GC-to-AT transition [[mutations]].<ref name="pmid12369930">{{cite journal |vauthors=Caradonna S, Muller-Weeks S |title=The nature of enzymes involved in uracil-DNA repair: isoform characteristics of proteins responsible for nuclear and mitochondrial genomic integrity |journal=Curr. Protein Pept. Sci. |volume=2 |issue=4 |pages=335–47 |date=December 2001 |pmid=12369930 |doi= |url=}}</ref>
*UNG removes [[uracil]] residues leading to [[DNA]] breaks that helps initiate class switching.
*UNG deficiency has an [[autosomal recessive]] mutation, this leads to  an normal or increased serum [[IgM]] concentrations with low or absent serum [[IgG]], [[IgA]], and [[IgE]] concentrations.
*Disease is characterized by increased susceptibility to [[bacterial infections]], [[lymphoid]] [[hyperplasia]] leading to enlarged [[lymph nodes]].<ref name="pmid12958596">{{cite journal |vauthors=Imai K, Slupphaug G, Lee WI, Revy P, Nonoyama S, Catalan N, Yel L, Forveille M, Kavli B, Krokan HE, Ochs HD, Fischer A, Durandy A |title=Human uracil-DNA glycosylase deficiency associated with profoundly impaired immunoglobulin class-switch recombination |journal=Nat. Immunol. |volume=4 |issue=10 |pages=1023–8 |date=October 2003 |pmid=12958596 |doi=10.1038/ni974 |url=}}</ref>
*Treatment is by [[immunoglobulin]] replacement therapy and treatment of [[infections]] with [[antibiotics]].<ref name="pmid20180797">{{cite journal |vauthors=Davies EG, Thrasher AJ |title=Update on the hyper immunoglobulin M syndromes |journal=Br. J. Haematol. |volume=149 |issue=2 |pages=167–80 |date=April 2010 |pmid=20180797 |pmc=2855828 |doi=10.1111/j.1365-2141.2010.08077.x |url=}}</ref>
==INO80==
*INO80 gene encodes for a subunit of the chromatin remodeling complex that is required for immunoglobulin class switching.
*Patients have normal or elevated IgM levels, but low switched immunoglobulin isotypes (IgG, IgA, IgE).
*Treatment is by [[Intravenous immunoglobulin|replacement of immunoglobulins]].<ref name="pmid25312759">{{cite journal |vauthors=Kracker S, Di Virgilio M, Schwartzentruber J, Cuenin C, Forveille M, Deau MC, McBride KM, Majewski J, Gazumyan A, Seneviratne S, Grimbacher B, Kutukculer N, Herceg Z, Cavazzana M, Jabado N, Nussenzweig MC, Fischer A, Durandy A |title=An inherited immunoglobulin class-switch recombination deficiency associated with a defect in the INO80 chromatin remodeling complex |journal=J. Allergy Clin. Immunol. |volume=135 |issue=4 |pages=998–1007.e6 |date=April 2015 |pmid=25312759 |pmc=4382329 |doi=10.1016/j.jaci.2014.08.030 |url=}}</ref>
==MSH6==
*MSH6 plays an important role  in induction and repair of DNA double-strand breaks in immunoglobulin isotype switch regions, and is also involved in somatic hypermutation.<ref name="pmid22250089">{{cite journal |vauthors=Gardès P, Forveille M, Alyanakian MA, Aucouturier P, Ilencikova D, Leroux D, Rahner N, Mazerolles F, Fischer A, Kracker S, Durandy A |title=Human MSH6 deficiency is associated with impaired antibody maturation |journal=J. Immunol. |volume=188 |issue=4 |pages=2023–9 |date=February 2012 |pmid=22250089 |doi=10.4049/jimmunol.1102984 |url=}}</ref>
==[[Selective IgA deficiency|Selective IgA Deficiency]] (SIgAD)==
*[[Selective IgA deficiency|Selective Immunoglobulin A (IgA) deficiency]] is the most common [[primary immunodeficiency]] and is defined as "serum level of [[Immunoglobulin A|IgA]] equal or below 7mg/dl in the presence of normal level of other [[immunoglobulins]] in individuals older than four years of age and in which other causes of [[hypogammaglobulinemia]] have been excluded".<ref name="pmid20101521">{{cite journal |vauthors=Yel L |title=Selective IgA deficiency |journal=J. Clin. Immunol. |volume=30 |issue=1 |pages=10–6 |date=January 2010 |pmid=20101521 |pmc=2821513 |doi=10.1007/s10875-009-9357-x |url=}}</ref>
*Several genetic [[Mutation|mutations]] are associated with [[Selective IgA deficiency|SIgAD]] which suggest its polygenic nature but most commonly it is due to a maturation defect in [[B cell|B cells]] to produce [[Immunoglobulin A|IgA]].<ref name="pmid10370371">{{cite journal |vauthors=Wang Z, Yunis D, Irigoyen M, Kitchens B, Bottaro A, Alt FW, Alper CA |title=Discordance between IgA switching at the DNA level and IgA expression at the mRNA level in IgA-deficient patients |journal=Clin. Immunol. |volume=91 |issue=3 |pages=263–70 |date=June 1999 |pmid=10370371 |doi=10.1006/clim.1999.4702 |url=}}</ref>
* [[B cell|B cells]] arrested at a stage where they coexpress surface [[Immunoglobulin M|IgM]], [[Immunoglobulin D|IgD]] as well as [[Immunoglobulin A|IgA]] and donot develop into [[Immunoglobulin A|IgA]] secreting plasma cells.<ref name="pmid6973088">{{cite journal |vauthors=Conley ME, Cooper MD |title=Immature IgA B cells in IgA-deficient patients |journal=N. Engl. J. Med. |volume=305 |issue=9 |pages=495–7 |date=August 1981 |pmid=6973088 |doi=10.1056/NEJM198108273050905 |url=}}</ref>.
*The abnormality appears to involve [[Stem cell|stem cells]] as it can be passed on by [[bone marrow transplantation]].<ref name="pmid2858666">{{cite journal |vauthors=Hammarström L, Lönnqvist B, Ringdén O, Smith CI, Wiebe T |title=Transfer of IgA deficiency to a bone-marrow-grafted patient with aplastic anaemia |journal=Lancet |volume=1 |issue=8432 |pages=778–81 |date=April 1985 |pmid=2858666 |doi= |url=}}</ref>
*Majority of the individuals are asymptomatic, but may present with recurrent respiratory and gastrointestinal infections (mucosal infections), [[Autoimmunity|autoimmune diseases]], [[atopy]] and [[anaphylaxis]] to [[Immunoglobulin A|IgA]] containing products.<ref name="pmid20101521">{{cite journal |vauthors=Yel L |title=Selective IgA deficiency |journal=J. Clin. Immunol. |volume=30 |issue=1 |pages=10–6 |date=January 2010 |pmid=20101521 |pmc=2821513 |doi=10.1007/s10875-009-9357-x |url=}}</ref>
*[[Immunoglobulin A|IgA]] levels should be periodically monitored in asymptomatic patients.
*There is no specific treatment for [[Selective immunoglobulin A deficiency|selective IgA deficiency]]. Individuals can be managed based on their symptoms as the presentation varies.
*Antibiotics are used to treat bacterial infections in patients with [[Selective IgA deficiency|SIgAD]].
*Prophylactic antibiotics can be used for recurrent [[Infection|infections]].
*If prophylactic antibiotics fail, a trial of intravenous or subcutaneous [[immunoglobulin]] replacement therapy with minimal component of [[Immunoglobulin A|IgA]] may be tried.
*Serum [[Immunoglobulin A|IgA]] antibodies should always be checked in such patient before administration of [[Intravenous immunoglobulin|IVIG]] to prevent the risk of [[anaphylaxis]].
*If [[blood transfusion]] is required, [[Selective IgA deficiency|IgA deficient]] or washed blood components should be used.<ref name="pmid9544978">{{cite journal |vauthors=Rogers RL, Javed TA, Ross RE, Virella G, Stuart RK, Frei-Lahr D |title=Transfusion management of an IgA deficient patient with anti-IgA and incidental correction of IgA deficiency after allogeneic bone marrow transplantation |journal=Am. J. Hematol. |volume=57 |issue=4 |pages=326–30 |date=April 1998 |pmid=9544978 |doi= |url=}}</re
*Patient with severe IgA deficiency can have anaphylactic reactions secondary to blood transfusion or its products. It is specifically seen in patients with undetectable serum IgA levels. These patients develop anti IgA antibodies so they should be advised to wear medical alert bracelet.<nowiki><ref name="pmid17137841"></nowiki>{{cite journal |vauthors=Horn J, Thon V, Bartonkova D, Salzer U, Warnatz K, Schlesier M, Peter HH, Grimbacher B |title=Anti-IgA antibodies in common variable immunodeficiency (CVID): diagnostic workup and therapeutic strategy |journal=Clin. Immunol. |volume=122 |issue=2 |pages=156–62 |date=February 2007 |pmid=17137841 |doi=10.1016/j.clim.2006.10.002 |url=}}</ref><ref name="pmid3945295">{{cite journal |vauthors=Burks AW, Sampson HA, Buckley RH |title=Anaphylactic reactions after gamma globulin administration in patients with hypogammaglobulinemia. Detection of IgE antibodies to IgA |journal=N. Engl. J. Med. |volume=314 |issue=9 |pages=560–4 |date=February 1986 |pmid=3945295 |doi=10.1056/NEJM198602273140907 |url=}}</ref><ref name="pmid20101521">{{cite journal |vauthors=Yel L |title=Selective IgA deficiency |journal=J. Clin. Immunol. |volume=30 |issue=1 |pages=10–6 |date=January 2010 |pmid=20101521 |pmc=2821513 |doi=10.1007/s10875-009-9357-x |url=}}</ref>
*[[Pneumococcal vaccine]] is recommended in patients with [[Selective IgA deficiency|SIgAD]] to reduce the risk of sino-pulmonary infections.
==Kappa chain Deficiency==
*Approximately 2/3 of the total immunoglobulins light chains, circulating and surface bound, are Kappa [[Light chain|light chains]].
*Deficiency is due to a genetic defect causing [[homozygous]] T to G substitution which leads to absent kappa [[Light chain|light chain immunoglobulins]], but the concentration of [[immunoglobulin]] isotypes ([[Immunoglobulin G|IgG]], [[IgA]], [[IgM]], [[IgE]] and [[Immunoglobulin D|IgD]]) are normal due to compensation by lambda [[Light chain|light chains]].
*This leads to increased susceptibility bacterial infections of respiratory and [[Gastrointestinal tract|gastrointestinal system]], [[autoimmunity]] and IgA deficiency.
*Patients require frequent hospitalization and [[antibiotic]] therapy to treat recurrent infections.<ref name="pmid26853951">{{cite journal |vauthors=Sala P, Colatutto A, Fabbro D, Mariuzzi L, Marzinotto S, Toffoletto B, Perosa AR, Damante G |title=Immunoglobulin K light chain deficiency: A rare, but probably underestimated, humoral immune defect |journal=Eur J Med Genet |volume=59 |issue=4 |pages=219–22 |date=April 2016 |pmid=26853951 |doi=10.1016/j.ejmg.2016.02.003 |url=}}</ref><ref name="pmid815819">{{cite journal |vauthors=Zegers BJ, Maertzdorf WJ, Van Loghem E, Mul NA, Stoop JW, Van Der Laag J, Vossen JJ, Ballieux RE |title=Kappa-chain deficiency. An immunoglobulin disorder |journal=N. Engl. J. Med. |volume=294 |issue=19 |pages=1026–30 |date=May 1976 |pmid=815819 |doi=10.1056/NEJM197605062941902 |url=}}</ref><ref name="pmid3931219">{{cite journal |vauthors=Stavnezer-Nordgren J, Kekish O, Zegers BJ |title=Molecular defects in a human immunoglobulin kappa chain deficiency |journal=Science |volume=230 |issue=4724 |pages=458–61 |date=October 1985 |pmid=3931219 |doi= |url=}}</ref>
==Selective IgM Deficiency==
*Selective IgM deficiency (SIGMD) is defined as "serum [[Immunoglobulin M|IgM]] levels below two SD of mean with normal serum IgG IgA and T cells".<ref name="pmid4168495">{{cite journal |vauthors=Hobbs JR, Milner RD, Watt PJ |title=Gamma-M deficiency predisposing to meningococcal septicaemia |journal=Br Med J |volume=4 |issue=5579 |pages=583–6 |date=December 1967 |pmid=4168495 |pmc=1749295 |doi= |url=}}</ref>
*Cause of IgM deficiency is due to many genetic defects, but commonly due to  22q11.2 [[chromosome]] deletion.
*Individuals with SIGMD present with increased susceptibility to [[Infection|infections]] by [[Microorganism|microorganisms]] and [[protozoa]], [[atopy]], impaired [[antibody]] response and [[autoimmune]] diseases.
*Treatment is via [[immunoglobulin]] replacement and treatment of infection with [[Antibiotic|antibiotics]].<ref name="pmid28928736">{{cite journal |vauthors=Gupta S, Gupta A |title=Selective IgM Deficiency-An Underestimated Primary Immunodeficiency |journal=Front Immunol |volume=8 |issue= |pages=1056 |date=2017 |pmid=28928736 |pmc=5591887 |doi=10.3389/fimmu.2017.01056 |url=}}</ref><ref name="pmid23760686">{{cite journal |vauthors=Louis AG, Gupta S |title=Primary selective IgM deficiency: an ignored immunodeficiency |journal=Clin Rev Allergy Immunol |volume=46 |issue=2 |pages=104–11 |date=April 2014 |pmid=23760686 |doi=10.1007/s12016-013-8375-x |url=}}</ref>
==CARD11 Gain of Function==
*[[CARD11|Caspase recruitment domain-containing family member 11]] ([[CARD11]]) is a scaffold protein which plays a crucial role in antigen receptor induced NF-kB activation, [[B cell]] differentiation, and functioning of effector [[T cell]].<ref name="pmid23374270">{{cite journal |vauthors=Stepensky P, Keller B, Buchta M, Kienzler AK, Elpeleg O, Somech R, Cohen S, Shachar I, Miosge LA, Schlesier M, Fuchs I, Enders A, Eibel H, Grimbacher B, Warnatz K |title=Deficiency of caspase recruitment domain family, member 11 (CARD11), causes profound combined immunodeficiency in human subjects |journal=J. Allergy Clin. Immunol. |volume=131 |issue=2 |pages=477–85.e1 |date=February 2013 |pmid=23374270 |doi=10.1016/j.jaci.2012.11.050 |url=}}</ref>
*CARD11 gain of function mutations are associated with a disorder known as [[B cell]] expansion with NF-kB and T cell anergy (BENTA) disease.
*Patients present with enlarged [[lymph nodes]] and [[splenomegaly]] at infancy.
*Mutation leads to congenital [[B cell]] [[Lymphoproliferative disorders|lymphoproliferation]], impaired [[T cell]] response to antigen receptor activation, decrease in number of [[Immunoglobulin|immunoglobulins]], recurrent sinopulmonary [[infections]], decreased response to [[vaccines]] and [[malignancies]] due to overactive [[NF-kB]].<ref name="pmid23129749">{{cite journal |vauthors=Snow AL, Xiao W, Stinson JR, Lu W, Chaigne-Delalande B, Zheng L, Pittaluga S, Matthews HF, Schmitz R, Jhavar S, Kuchen S, Kardava L, Wang W, Lamborn IT, Jing H, Raffeld M, Moir S, Fleisher TA, Staudt LM, Su HC, Lenardo MJ |title=Congenital B cell lymphocytosis explained by novel germline CARD11 mutations |journal=J. Exp. Med. |volume=209 |issue=12 |pages=2247–61 |date=November 2012 |pmid=23129749 |pmc=3501355 |doi=10.1084/jem.20120831 |url=}}</ref><ref name="pmid26406182">{{cite journal |vauthors=Arjunaraja S, Snow AL |title=Gain-of-function mutations and immunodeficiency: at a loss for proper tuning of lymphocyte signaling |journal=Curr Opin Allergy Clin Immunol |volume=15 |issue=6 |pages=533–8 |date=December 2015 |pmid=26406182 |pmc=4672729 |doi=10.1097/ACI.0000000000000217 |url=}}</ref><ref name="pmid18323416">{{cite journal |vauthors=Lenz G, Davis RE, Ngo VN, Lam L, George TC, Wright GW, Dave SS, Zhao H, Xu W, Rosenwald A, Ott G, Muller-Hermelink HK, Gascoyne RD, Connors JM, Rimsza LM, Campo E, Jaffe ES, Delabie J, Smeland EB, Fisher RI, Chan WC, Staudt LM |title=Oncogenic CARD11 mutations in human diffuse large B cell lymphoma |journal=Science |volume=319 |issue=5870 |pages=1676–9 |date=March 2008 |pmid=18323416 |doi=10.1126/science.1153629 |url=}}</ref>
*No definitive treatment, patients are monitored and treated for [[infections]] and in a few cases via [[splenectomy]] to decrease [[B cell]] load.<ref name="pmid25087226">{{cite journal |vauthors=Turvey SE, Durandy A, Fischer A, Fung SY, Geha RS, Gewies A, Giese T, Greil J, Keller B, McKinnon ML, Neven B, Rozmus J, Ruland J, Snow AL, Stepensky P, Warnatz K |title=The CARD11-BCL10-MALT1 (CBM) signalosome complex: Stepping into the limelight of human primary immunodeficiency |journal=J. Allergy Clin. Immunol. |volume=134 |issue=2 |pages=276–84 |date=August 2014 |pmid=25087226 |pmc=4167767 |doi=10.1016/j.jaci.2014.06.015 |url=}}</ref>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 17:22, 14 December 2018

Immunodeficiency Main Page

Home

Overview

Classification

Immunodeficiency Affecting Cellular and Humoral Immunity

Combined Immunodeficiency

Predominantly Antibody Deficiency

Diseases of Immune Dysregulation

Congenital Defects of Phagocytes

Defects in Intrinsic and Innate Immunity

Auto-inflammatory Disorders

Complement Deficiencies

Phenocopies of Primary Immunodeficiency

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Preeti Singh, M.B.B.S.[2], Ali Akram, M.B.B.S.[3], Anmol Pitliya, M.B.B.S. M.D.[4]

Overview

Predominantly antibody deficiencies (PAD) are the most common type of primary immunodeficiency diseases (PID). PAD is a large group of diseases which may vary widely from having a complete absence of B cells and decrease in all immunoglobulins to having deficiency in specific immunoglobulins. Depending on the phenotype, agammaglobulinemia or CVID, patients can present either in infancy or adulthood.The main clinical characteristic of patients with PAD is recurrent bacterial infections, low levels of immunoglobulin (ranging from agammaglobulinemia to hypogammaglobulinemia), and impaired response to vaccines and antigens. Treatment is by intravenous or subcutaneous immunoglobulins and treatment of infections by antibiotics.

Classification

 
 
Predominantly antibody deficiencies
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hypogammaglobulinemia
 
Other antibody deficiencies


Hypogammaglobulinemia


 
 
 
 
Predominantly antibody deficiencies
(A): Hypogammaglobulinemia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Serum immunoglobulin assays : IgG, IgA, IgM, IgE
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
IgG, IgA, and/or IgM ↓↓
→ B Lymphocyte (CD19+) enumeration (CMF)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
B absent
 
 
 
B >1%
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
X-Linked Agammaglobulinemia
 
Common Variable Immunodeficiency Phenotype
 
 
 
CD19 deficiency
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
µ heavy chain Def
 
 
 
CVID with no gene defect specified
 
 
CD20 deficiency
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Igα def
 
 
 
PIK3CD mutation(GOF),PIK3R1 deficiency(LOF)
 
 
CD21 deficiency
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Igβ def
 
 
 
PTEN deficiency(LOF)
 
 
TRNT1 deficiency
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
BLNK def
 
 
 
CD81 deficiency
 
 
NFKB1 deficiency
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
λ5 def
 
 
 
TACI deficiency
 
 
NFKB2 deficiency
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
PI3KR1 def
 
 
 
BAFF receptor deficiency
 
 
IKAROS deficiency
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
E47 transcription factor def
 
 
 
TWEAK deficiency
 
 
ATP6AP1 deficiency
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mannosyl-oligosaccharide glucosidase deficiency (MOGS)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
TTC37 deficiency
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
IRF2BP2 deficiency
 
 
 
 
 
 

Other Antibody deficiencies

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Predominantly antibody deficiencies
(B): Other antibody deficiencies
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Serum Immunolobulin Assays: IgG, IgA, IgM, IgE
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Severe Reduction in Serum IgG and IgA with NI/elevated IgM and Normal Numbers of B cells: Hyper IgM Syndromes
 
 
 
 
Isotype, Light Chain, or Functional Deficiencies with Generally NI Numbers of B cells
 
 
 
High B cell numbers due to constitutive NF-kB activation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
AID deficiency
 
 
 
 
 
Selective IgA deficiency
 
 
 
 
CARD11 Gain of Function
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
UNG deficiency
 
 
 
 
 
Transient hypogammaglobuliemia of infancy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
INO80
 
 
 
 
 
IgG subclass deficiency with IgA deficiency
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
MSH6
 
 
 
 
 
Isolated IgG subclass deficiency
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Specific antibody deficiency with normal Ig levels and normal B cells
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ig heavy chain muations and deletions
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Kappa chain deficiency
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Selective IgM deficiency
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

X-linked Agammaglobulinemia

  • It is an X linked disease, first described by Bruton in 1952.
  • It is caused by the mutation of BTK gene (present on the long arm of X chromosome) which encodes for the protein Bruton tyrosine kinase,which is associated with the maturation and differentiation of the pre B cell.[1]
  • The disruption of this protein can lead to significant decrease in all antibody isotypes, due to failure of Ig heavy chain rearrangement.[2]
  • Affected individuals generally present between 3 months to 3 years of age, with almost 90% becoming symptomatic by 5 years of age.[3]
  • Presence of maternal immunoglobulins provide transient protection, concealing symptoms of the disease and preventing early detection.
  • Physical examination typically shows absence of lymph nodes.
  • Patients are susceptible to recurrent infections with encapsulated organisms and enteroviruses, primarily effecting respiratory and gastrointestinal tracts.
  • Laboratory findings show defect in humoral immunity with absence or negligible amount of IgM, IgG, and IgA, as well as <2% of B cells lymphocytes. Neutropenia can also be seen.[4][1][5]
  • Treatment is mainly via hematopoietic stem cell therapy and through replacement of immunoglobulins either by intravenous or subcutaneous routes. Recurrent infections are prevented and treated by antibiotics.[6]

For more information on X-linked agammaglobulinemia, click here.

µ Heavy Chain Deficiency

Igα Deficiency

Igβ Deficiency

BLNK Deficiency

λ5 Deficiency

PI3KR1 Deficiency

E47 transcription factor Deficiency

CVID With No Gene Specified

  1. Hypogammaglobulinaemia with IgG levels two standard deviations below the mean.
  2. Impaired vaccine responses or absent isohemagglutinins.
  3. Exclusion of other causes of hypogammaglobulinaemia.
  • Patients are susceptible to recurrent infections, autoimmunity and malignancy.
  • Treatment is by intravenous or subcutaneous replacement of immunoglobulins.[20]

PIK3CD mutation,PIK3R1 deficiency

  • Also known as activated phosphoinositide 3-kinase δ syndrome (APDS).
  • Autosomal dominant gain of function (GOF) mutation of PIK3CD gene, which encodes for P110δ subunit of phosphoinositide 3-kinase (PI3K) and loss of function (LOF) mutation of PIK3R1 gene, which encodes the p85α subunit of PI3K.
  • Mutations in PIK3CD gene leads to clinical features similar to mutation in PIK3R1 gene.[21]
  • Patients with mutations of gene for PIK3R1 show characteristics similar to that of patients carrying gain-of-function mutations of PIK3CD gene.
  • Mutations lead to hyperactive PI3K/AKT/mTOR signaling.[15][22]
  • Disease is characterized by low numbers of naive T cells, but a larger number of senescent effector T cells.
  • Patients present with upper and lower respiratory tract infections, lymphadenopathy, nodular lymphoid hyperplasia, early-onset autoimmunity, malignancies and recurrent viral infections with cytomegalovirus (CMV) and Epstein Barr virus (EBV).[23]
  • Treatment is via sirolimus and selective PI3Kδ inhibitors, intavenous and subcutaneous immunoglobulin replacement, prophylactic antibiotic, and hematopoietic stem cell transplant.[24]

PTEN deficiency

CD 81 Deficiency

TACI Deficiency

  • Transmembrane activator and calcium-modulator and cyclophilin ligand interactor (TACI) is a part of tumor necrosis factor family and involved in B cell class switching.
  • Missense mutation of one allele of TNFRSF13B gene encoding for TACI leads to CVID like immunodeficiency.[28]
  • Patients present with increased susceptibility to encapsulated organisms, autoimmunity, and hypogammaglobulinemia.[29][30]
  • Treatment is by intravenous or subcutaneous replacement of immunoglobulins.[20]

BAFF Receptor Deficiency

  • Mutation of B-cell activating factor receptor (BAFF-R) prevents maturation of transitional B cell, leading to a CVID type adult onset immunodeficiency.
  • Incomplete maturation leads to hypogammaglobulinemia, but can in a few cases not manifest to clinical disease, with recurrent infections.
  • Patients show varying degrees immunodeficiency but normal IgA levels.[31][32]
  • Treatment is by intravenous or subcutaneous replacement of immunoglobulins and by curative antibiotics.[20]

TWEAK Deficiency

MOGS Deficiency

  • Mannosyl-oligosaccharide glucosidase (MOGS) deficiency causes a congenital disorder of glycosylation type IIb (CDG-IIb), also known as MOGS-CDG.
  • MOGS deficiency leads to improper processing of immunoglobulins, which shortens their half-life in circulation.
  • Few studies show that unlike most antibody deficiencies MOGS deficiency does not lead to clinical features of hypogammaglobulinemia like recurrent infections.
  • This is because cells with MOGS deficiency have altered glycosylation which prevents productive infection of multiple enveloped viruses.[34][35]

TTC37 Deficiency

  • Tetratricopeptide Repeat Domain 37 (TTC37) deficency is an autosomal recessive disease causing syndromic diarrhea/tricho-hepato-enteric syndrome (SD/THE) which has a similar immune phenotype to CVID.
  • TTC37 is involved in aberrant mRNAs decay.
  • Patient presents in infancy with low IgG and poor antigen-stimulation to vaccine.
  • Clinical features show infantile onset refractory diarrhea, hair and facial anomalies.[36][37]
  • Treatment is by intravenous or subcutaneous replacement of immunoglobulins and by curative antibiotics.[20]

IRF2BP2 Deficiency

  • Interferon Regulatory Factor 2 Binding Protein 2 (IRF2BP2) mutation leads to impaired differentiation of B cells.
  • Few studies show that most patients with this mutation are diagnosed with CVID in childhood.
  • Disease is characterized by recurrent infections,low levels of IgG, IgA and IgM , and decreased number of memory B cells. There is no T cell dysfunction.[38]
  • Treatment is by intravenous or subcutaneous replacement of immunoglobulins and by curative antibiotics.[20]

CD19 Deficiency

CD20 Deficiency

CD21 Deficiency

TRNT1 Deficiency

NFKB1 Deficiency

NFKB2 Deficiency

IKAROS Deficiency

  • IKAROS gene encodes for a family of hemopoietic-specific zinc finger proteins which are essential for lymphocyte development.[50]
  • Individuals show varied severity of clinical disease, despite most patients having low B cell and antibody count.
  • Deficiency leads to hypogammaglobulinemia, decreased response to vaccines, recurrent bacterial infections and malignancies.
  • Treatment is via replacement of immunoglobulins and treatment of infections with antibiotics.[51]

ATP6AP1 Deficiency

AID Deficiency

UNG deficiency

INO80

  • INO80 gene encodes for a subunit of the chromatin remodeling complex that is required for immunoglobulin class switching.
  • Patients have normal or elevated IgM levels, but low switched immunoglobulin isotypes (IgG, IgA, IgE).
  • Treatment is by replacement of immunoglobulins.[60]

MSH6

  • MSH6 plays an important role in induction and repair of DNA double-strand breaks in immunoglobulin isotype switch regions, and is also involved in somatic hypermutation.[61]

Selective IgA Deficiency (SIgAD)

Kappa chain Deficiency

Selective IgM Deficiency

CARD11 Gain of Function

References

  1. 1.0 1.1 Hernandez-Trujillo VP, Scalchunes C, Cunningham-Rundles C, Ochs HD, Bonilla FA, Paris K, Yel L, Sullivan KE (August 2014). "Autoimmunity and inflammation in X-linked agammaglobulinemia". J. Clin. Immunol. 34 (6): 627–32. doi:10.1007/s10875-014-0056-x. PMC 4157090. PMID 24909997.
  2. Rawlings DJ, Witte ON (April 1994). "Bruton's tyrosine kinase is a key regulator in B-cell development". Immunol. Rev. 138: 105–19. PMID 8070812.
  3. Winkelstein JA, Marino MC, Lederman HM, Jones SM, Sullivan K, Burks AW, Conley ME, Cunningham-Rundles C, Ochs HD (July 2006). "X-linked agammaglobulinemia: report on a United States registry of 201 patients". Medicine (Baltimore). 85 (4): 193–202. doi:10.1097/01.md.0000229482.27398.ad. PMID 16862044.
  4. Fried AJ, Bonilla FA (July 2009). "Pathogenesis, diagnosis, and management of primary antibody deficiencies and infections". Clin. Microbiol. Rev. 22 (3): 396–414. doi:10.1128/CMR.00001-09. PMC 2708392. PMID 19597006.
  5. Berglöf A, Turunen JJ, Gissberg O, Bestas B, Blomberg KE, Smith CI (December 2013). "Agammaglobulinemia: causative mutations and their implications for novel therapies". Expert Rev Clin Immunol. 9 (12): 1205–21. doi:10.1586/1744666X.2013.850030. PMID 24215410.
  6. 6.0 6.1 Cunningham-Rundles C (June 2011). "Key aspects for successful immunoglobulin therapy of primary immunodeficiencies". Clin. Exp. Immunol. 164 Suppl 2: 16–9. doi:10.1111/j.1365-2249.2011.04390.x. PMC 3087906. PMID 21466548.
  7. Yel L, Minegishi Y, Coustan-Smith E, Buckley RH, Trübel H, Pachman LM, Kitchingman GR, Campana D, Rohrer J, Conley ME (November 1996). "Mutations in the mu heavy-chain gene in patients with agammaglobulinemia". N. Engl. J. Med. 335 (20): 1486–93. doi:10.1056/NEJM199611143352003. PMID 8890099.
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