Leukocyte adhesion deficiency (LAD)-III is associated with homozygous stop codon mutations in Kindlin-3, the hematopoietic member of the Kindlin family of integrin coactivators. In addition, a subgroup of LAD-III patients has a homozygous splice junction mutation in and reduced expression of the Rap-1 guanine nucleotide exchange factor, CalDAG-GEFI (CDGI). In this study, we compared the adhesive properties of the leukocyte function-associated antigen-1 (LFA-1) and very late activation antigen-4 (VLA-4) integrins in both primary and activated leukocytes derived from these 2 LAD-III subgroups. Primary lymphocytes lacking both Kindlin-3 and CDGI lost all firm T-cell receptor-stimulated LFA-1 adhesiveness, in contrast to LAD-III lymphocytes deficient in Kindlin-3 alone. Effector T cells expanded from all tested LAD-III variants expressed normal CDGI, but lacked Kindlin-3. These Kindlin-3-null effector T cells exhibited total loss of inside-out
IntroductionIntegrins constitute the major and largest family of cell adhesion receptors. 1 In hematopoietic cells, these heterodimers rapidly undergo dramatic allosteric conformational changes in response to various activation signals. 2 Talins are key integrin activators implicated in these processes in essentially all integrin-containing cell types. 3 Activated integrins are essential for platelet aggregation, firm leukocyte adhesiveness to vascular endothelium, and lymphocyte arrest on antigen-presenting cells. 4 Recent evidence suggests that Kindlins, a group of 3 structurally related adaptors, cooperate with talin in activating integrins in different cell types through binding to distinct motifs on the short tails of the integrin  subunits. [5][6][7][8] In contrast to Kindlins-1 and -2, Kindlin-3 expression is restricted to the hematopoietic system. 7 Whereas loss of talin1 is embryonically lethal, deletion of Kindlin-3 is not; 7 yet, deletion of Kindlin-3 in mice results in severe defects in platelet and leukocyte integrin activation and in reduced lymphocyte counts, 7,9 osteoporosis, 7 and abnormal erythrocyte function, which is ultimately fatal. 10 Although a recent study has directly implicated murine Kindlin-3 in neutrophil and monocyte integrin adhesiveness to inflamed endothelium in vitro and in vivo, 9 the role of Kindlin-3 in inside-out (chemokine-mediated) and outside-in (ligand-induced) activation of lymphocyte integrins has remained unexplored.Leukocyte adhesion deficiency (LAD)-III is a rare autosomal recessive syndrome, which is manifested as a combined defect in  3 ,  2 , and  1 integrin activation in platelets, neutrophils, and lymphocytes. 11 We previously reported 3 LAD-III cases from families of Turkish origin, associated with a homozygous splice junction mutation that results in defective expression of a key Rap-1-specific guanine nucleotide exchange factor (Rap-1/2 GEF), CalDAG-GEFI (CDGI), in platelets, neutrophils, and resting lymphocytes. 12 We recently showed that these patients suffer from an additional mutation, a homozygous nonsense stop ...