Journal Article

Genetic, Cellular and Clinical Features of ICF Syndrome: a French National Survey

Francastel, Claire, Mahlaoui, Nizar, Sterlin, Delphine, Touzot, Fabien, Fischer, Alain, Suarez, Felipe, Moshous, Despina, Velasco, Guillaume, Picard, Capucine

2016

Overview

Purpose Autosomal recessive deficiencies of DNMT3B or ZBTB24 account for two-thirds of cases of immunodeficiency, centromeric instability and facial dysmorphism (ICF syndrome). This primary immunodeficiency (PID) is characterized mainly by an antibody deficiency, facial abnormalities and centromeric instability. We analyzed the national cohort of patients with ICF syndrome with the aim of providing a more detailed description of the phenotype and management of patients with ICF syndrome. Methods Demographic, genetic, immunological, and clinical features were recorded for each patient. Results In the French cohort, seven of the nine patients carried DNMT3B mutations, six of which had never been described before. One patient had compound heterozygous ZBTB24  mutations. All patients were found to lack CD19 + CD27 + memory B cells. This feature is a major diagnostic criterion for both ICF1 and ICF2. Patients suffered both bacterial and viral infections, and three patients developed bronchiectasis. Autoimmune manifestations (hepatitis, nephritis and thyroiditis) not previously reported in ICF1 patients were also detected in two of our ICF1 patients. The mode of treatment and outcome of the French patients are reported, by genetic defect, and compared with those for 68 previously reported ICF patients. Immunoglobulin (Ig) replacement treatment was administered to all nine French patients. One ICF1 patient presented severe autoimmune manifestations and pancytopenia and underwent allogeneic hematopoietic stem cell transplantation (HSCT), but she died from unknown causes 6 years post-transplant. Conclusion Autoimmune signs are uncommon in ICF syndrome, but, when present, they affect patient outcome and require immunosuppressive treatment. The long-term outcome of ICF patients has been improved by the combination of IgG replacement and antibiotic prophylaxis.

• Publisher: Springer US,Springer Nature B.V,Springer Verlag
• Subject: Autoimmunity / Biomedical and Life Sciences / Biomedicine / Child / Child, Preschool / Disease Management / Female / France - epidemiology / Genetic Predisposition to Disease / Genetic Testing / Humans / Immunologic Deficiency Syndromes - diagnosis / Immunologic Deficiency Syndromes - epidemiology / Immunologic Deficiency Syndromes - etiology / Immunologic Deficiency Syndromes - therapy / Immunologic Tests / Immunology / Infant / Infant, Newborn / Infection - etiology / Infectious Diseases / Internal Medicine / Life Sciences / Male / Medical Microbiology / Mutation / Original Article / Outcome Assessment (Health Care) / Phenotype / Population Surveillance