Human germline heterozygous gain-of-function<i>STAT6</i>variants cause severe allergic disease

  • Mehul Sharma
    Dept. of Pediatrics, BC Children’s Hospital, University of British Columbia 1 , Vancouver, Canada
  • Daniel Leung
    Dept. of Paediatrics and Adolescent Medicine, School of Clinical Medicine, The University of Hong Kong 2 , Hong Kong, China
  • Mana Momenilandi
    3 , Paris, France
  • Lauren C.W. Jones
    Dept. of Pediatrics, BC Children’s Hospital, University of British Columbia 1 , Vancouver, Canada
  • Lucia Pacillo
    Dept. of System Medicine, Pediatric Chair, University of Tor Vergata 5 , Rome, Italy
  • Alyssa E. James
    Translational Allergic Immunopathology Unit, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases (NIAID), 8 , Bethesda, MD, USA
  • Jill R. Murrell
    Pathology and Laboratory Medicine, Division of Genomic Diagnostics, Children’s Hospital of Philadelphia 9 , Philadelphia, PA, USA
  • Selket Delafontaine
    Dept. of Microbiology, Immunology and Transplantation, Laboratory for Inborn Errors of Immunity, KU Leuven 10 , Leuven, Belgium
  • Jesmeen Maimaris
    Institute of Immunity and Transplantation, Division of Infection and Immunity, University College London 12 , London, UK
  • Maryam Vaseghi-Shanjani
    Dept. of Pediatrics, BC Children’s Hospital, University of British Columbia 1 , Vancouver, Canada
  • Kate L. Del Bel
    Dept. of Pediatrics, BC Children’s Hospital, University of British Columbia 1 , Vancouver, Canada
  • Henry Y. Lu
    Division of Hematology/Oncology, Boston Children’s Hospital 14 , , Boston, MA, USA
  • Gilbert T. Chua
    Dept. of Paediatrics and Adolescent Medicine, School of Clinical Medicine, The University of Hong Kong 2 , Hong Kong, China
  • Silvia Di Cesare
    Dept. of System Medicine, Pediatric Chair, University of Tor Vergata 5 , Rome, Italy
  • Oriol Fornes
    Centre for Molecular Medicine and Therapeutics, BC Children’s Hospital Research Institute 18 , Vancouver, Canada
  • Zhongyi Liu
    Dept. of Paediatrics and Adolescent Medicine, School of Clinical Medicine, The University of Hong Kong 2 , Hong Kong, China
  • Gigliola Di Matteo
    Academic Dept. of Pediatrics (DPUO), 6 , Rome, Italy
  • Maggie P. Fu
    Dept. of Medical Genetics, The University of British Columbia 20 , Vancouver, Canada
  • Donato Amodio
    Academic Dept. of Pediatrics (DPUO), 6 , Rome, Italy
  • Issan Yee San Tam
    Dept. of Paediatrics and Adolescent Medicine, School of Clinical Medicine, The University of Hong Kong 2 , Hong Kong, China
  • Gavin Shueng Wai Chan
    Dept. of Pathology, Queen Mary Hospital 22 , Hong Kong, China
  • Ashish A. Sharma
    Dept. of Pathology, Emory University 23 , Atlanta, GA, USA
  • Joshua Dalmann
    Dept. of Pediatrics, BC Children’s Hospital, University of British Columbia 1 , Vancouver, Canada
  • Robin van der Lee
    Centre for Molecular Medicine and Therapeutics, BC Children’s Hospital Research Institute 18 , Vancouver, Canada
  • Géraldine Blanchard-Rohner
    Dept. of Pediatrics, BC Children’s Hospital, University of British Columbia 1 , Vancouver, Canada
  • Susan Lin
    Dept. of Pediatrics, BC Children’s Hospital, University of British Columbia 1 , Vancouver, Canada
  • Quentin Philippot
    3 , Paris, France
  • Phillip A. Richmond
    Dept. of Pediatrics, BC Children’s Hospital, University of British Columbia 1 , Vancouver, Canada
  • Jessica J. Lee
    Centre for Molecular Medicine and Therapeutics, BC Children’s Hospital Research Institute 18 , Vancouver, Canada
  • Allison Matthews
    Centre for Molecular Medicine and Therapeutics, BC Children’s Hospital Research Institute 18 , Vancouver, Canada
  • Michael Seear
    Dept. of Pediatrics, BC Children’s Hospital, University of British Columbia 1 , Vancouver, Canada
  • Alexandra K. Turvey
    Dept. of Pediatrics, BC Children’s Hospital, University of British Columbia 1 , Vancouver, Canada
  • Rachael L. Philips
    Molecular Immunology and Inflammation Branch, National Institute of Arthritis, Musculoskeletal and Skin Diseases, NIH 27 , Bethesda, MD, USA
  • Terri F. Brown-Whitehorn
    Dept. of Pediatrics, Division of Allergy and Immunology, Children’s Hospital of Philadelphia 28 , Philadelphia, PA, USA
  • Christopher J. Gray
    Pediatrics, Division of Human Genetics, Children’s Hospital of Philadelphia 29 , Philadelphia, PA, USA
  • Kosuke Izumi
    Pediatrics, Division of Human Genetics, Children’s Hospital of Philadelphia 29 , Philadelphia, PA, USA
  • James R. Treat
    Pediatrics, Division of Pediatric Dermatology, Perelman School of Medicine, University of Pennsylvania 30 , Philadelphia, PA, USA
  • Kathleen H. Wood
    Pathology and Laboratory Medicine, Division of Genomic Diagnostics, Children’s Hospital of Philadelphia 9 , Philadelphia, PA, USA
  • Justin Lack
    NIAID Collaborative Bioinformatics Resource, NIAID 31 , , Bethesda, MD, USA
  • Asya Khleborodova
    NIAID Collaborative Bioinformatics Resource, NIAID 31 , , Bethesda, MD, USA
  • Julie E. Niemela
    Immunology Service, Clinical Center, NIH 32 , Bethesda, MD, USA
  • Xingtian Yang
    Dept. of Paediatrics and Adolescent Medicine, School of Clinical Medicine, The University of Hong Kong 2 , Hong Kong, China
  • Rui Liang
    Dept. of Paediatrics and Adolescent Medicine, School of Clinical Medicine, The University of Hong Kong 2 , Hong Kong, China
  • Lin Kui
    Dept. of Paediatrics and Adolescent Medicine, School of Clinical Medicine, The University of Hong Kong 2 , Hong Kong, China
  • Christina Sze Man Wong
    Dept. of Medicine, Divison of Dermatology, The University of Hong Kong 34 , Hong Kong, China
  • Grace Wing Kit Poon
    Dept. of Paediatrics and Adolescent Medicine, Queen Mary Hospital 35 , Hong Kong, China
  • Alexander Hoischen
    Dept. of Human Genetics, Radboud University Medical Center 36 , Nijmegen, Netherlands
  • Caspar I. van der Made
    Dept. of Human Genetics, Radboud University Medical Center 36 , Nijmegen, Netherlands
  • Jing Yang
    Dept. of Paediatrics and Adolescent Medicine, School of Clinical Medicine, The University of Hong Kong 2 , Hong Kong, China
  • Koon Wing Chan
    Dept. of Paediatrics and Adolescent Medicine, School of Clinical Medicine, The University of Hong Kong 2 , Hong Kong, China
  • Jaime Sou Da Rosa Duque
    Dept. of Paediatrics and Adolescent Medicine, School of Clinical Medicine, The University of Hong Kong 2 , Hong Kong, China
  • Pamela Pui Wah Lee
    Dept. of Paediatrics and Adolescent Medicine, School of Clinical Medicine, The University of Hong Kong 2 , Hong Kong, China
  • Marco Hok Kung Ho
    Dept. of Paediatrics and Adolescent Medicine, School of Clinical Medicine, The University of Hong Kong 2 , Hong Kong, China
  • Brian Hon Yin Chung
    Dept. of Paediatrics and Adolescent Medicine, School of Clinical Medicine, The University of Hong Kong 2 , Hong Kong, China
  • Huong Thi Minh Le
    Pediatric Center, Vinmec Times City International General Hospital 38 , Hanoi, Vietnam
  • Wanling Yang
    Dept. of Paediatrics and Adolescent Medicine, School of Clinical Medicine, The University of Hong Kong 2 , Hong Kong, China
  • Pejman Rohani
    Pediatrics, Pediatric Gastroenterology and Hepatology Research Center, Pediatrics Centre of Excellence, Children’s Medical Center, University of Medical Sciences 39 , Tehran, Iran
  • Ali Fouladvand
    Pediatrics, Allergy and Clinical Immunology, Lorestan University of Medical Sciences 40 , Khoramabad, Iran
  • Hassan Rokni-Zadeh
    Dept. of Medical Biotechnology, School of Medicine, Zanjan University of Medical Sciences 41 , Zanjan, Iran
  • Majid Changi-Ashtiani
    School of Mathematics, Institute for Research in Fundamental Sciences 42 , Tehran, Iran
  • Mohammad Miryounesi
    Dept. of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences 43 , Tehran, Iran
  • Anne Puel
    3 , Paris, France
  • Mohammad Shahrooei
    Microbiology and Immunology, Laboratory of Clinical Bacteriology and Mycology, KU Leuven 44 , Leuven, Belgium
  • Andrea Finocchi
    Dept. of System Medicine, Pediatric Chair, University of Tor Vergata 5 , Rome, Italy
  • Paolo Rossi
    Dept. of System Medicine, Pediatric Chair, University of Tor Vergata 5 , Rome, Italy
  • Beatrice Rivalta
    Dept. of System Medicine, Pediatric Chair, University of Tor Vergata 5 , Rome, Italy
  • Cristina Cifaldi
    Research Unit of Primary Immunodeficiency, 7 , Rome, Italy
  • Antonio Novelli
    Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children Hospital IRCCS 46 , Rome, Italy
  • Chiara Passarelli
    Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children Hospital IRCCS 46 , Rome, Italy
  • Stefania Arasi
    Allergy Unit, Area of Translational Research in Pediatric Specialities, Bambino Gesù Children’s Hospital, IRCCS 47 , Rome, Italy
  • Dominique Bullens
    Dept. of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven 48 , Leuven, Belgium
  • Kate Sauer
    Dept. of Pediatrics, Pediatric Pulmonology Division, AZ Sint-Jan Brugge 50 , Brugge, Belgium
  • Tania Claeys
    Dept. of Pediatrics, Pediatric Gastroenterology Division, AZ Sint-Jan Brugge 52 , Brugge, Belgium
  • Catherine M. Biggs
    Dept. of Pediatrics, BC Children’s Hospital, University of British Columbia 1 , Vancouver, Canada
  • Emma C. Morris
    Institute of Immunity and Transplantation, Division of Infection and Immunity, University College London 12 , London, UK
  • Sergio D. Rosenzweig
    Immunology Service, Clinical Center, NIH 32 , Bethesda, MD, USA
  • John J. O’Shea
    Molecular Immunology and Inflammation Branch, National Institute of Arthritis, Musculoskeletal and Skin Diseases, NIH 27 , Bethesda, MD, USA
  • Wyeth W. Wasserman
    Centre for Molecular Medicine and Therapeutics, BC Children’s Hospital Research Institute 18 , Vancouver, Canada
  • H. Melanie Bedford
    Dept. of Paediatrics, University of Toronto 26 , Toronto, Canada
  • Clara D.M. van Karnebeek
    Centre for Molecular Medicine and Therapeutics, BC Children’s Hospital Research Institute 18 , Vancouver, Canada
  • Paolo Palma
    Dept. of System Medicine, Pediatric Chair, University of Tor Vergata 5 , Rome, Italy
  • Siobhan O. Burns
    Institute of Immunity and Transplantation, Division of Infection and Immunity, University College London 12 , London, UK
  • Isabelle Meyts
    Dept. of Microbiology, Immunology and Transplantation, Laboratory for Inborn Errors of Immunity, KU Leuven 10 , Leuven, Belgium
  • Jean-Laurent Casanova
    3 , Paris, France
  • Jonathan J. Lyons
    Translational Allergic Immunopathology Unit, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases (NIAID), 8 , Bethesda, MD, USA
  • Nima Parvaneh
    57 , Tehran, Iran
  • Anh Thi Van Nguyen
    Dept. of Immunology, Allergy and Rheumatology, Division of Primary Immunodeficiency, Vietnam National Children’s Hospital 58 , Hanoi, Vietnam
  • Caterina Cancrini
    Dept. of System Medicine, Pediatric Chair, University of Tor Vergata 5 , Rome, Italy
  • Jennifer Heimall
    Dept. of Pediatrics, Division of Allergy and Immunology, Children’s Hospital of Philadelphia 28 , Philadelphia, PA, USA
  • Hanan Ahmed
    Faculty of Health Sciences, McMaster University 59 , Hamilton, Canada
  • Margaret L. McKinnon
    Dept. of Medical Genetics, University of British Columbia 19 , Vancouver, Canada
  • Yu Lung Lau
    Dept. of Paediatrics and Adolescent Medicine, School of Clinical Medicine, The University of Hong Kong 2 , Hong Kong, China
  • Vivien Béziat
    3 , Paris, France
  • Stuart E. Turvey
    Dept. of Pediatrics, BC Children’s Hospital, University of British Columbia 1 , Vancouver, Canada

抄録

<jats:p>STAT6 (signal transducer and activator of transcription 6) is a transcription factor that plays a central role in the pathophysiology of allergic inflammation. We have identified 16 patients from 10 families spanning three continents with a profound phenotype of early-life onset allergic immune dysregulation, widespread treatment-resistant atopic dermatitis, hypereosinophilia with esosinophilic gastrointestinal disease, asthma, elevated serum IgE, IgE-mediated food allergies, and anaphylaxis. The cases were either sporadic (seven kindreds) or followed an autosomal dominant inheritance pattern (three kindreds). All patients carried monoallelic rare variants in STAT6 and functional studies established their gain-of-function (GOF) phenotype with sustained STAT6 phosphorylation, increased STAT6 target gene expression, and TH2 skewing. Precision treatment with the anti–IL-4Rα antibody, dupilumab, was highly effective improving both clinical manifestations and immunological biomarkers. This study identifies heterozygous GOF variants in STAT6 as a novel autosomal dominant allergic disorder. We anticipate that our discovery of multiple kindreds with germline STAT6 GOF variants will facilitate the recognition of more affected individuals and the full definition of this new primary atopic disorder.</jats:p>

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