Two novel CD18 mutations were identified in a patient who was a compound heterozygote with type 1 leukocyte adhesion deficiency and whose phenotype was typical except that he exhibited hypertrophic scarring. A deletion of 36 nucleotides in exon 12 (1622del36) predicted the net loss of 12 amino acid (aa) residues in the third cysteine-rich repeat of the extracellular stalk region (mut-1). A nonsense mutation in exon 15 (2200G>T), predicted a 36-aa truncation of the cytoplasmic domain (mut-2). Lymphocyte functionassociated antigen 1 (LFA-1) and macrophage antigen-1 (Mac-1) containing the mut-1  2 subunit were expressed at very low levels compared with wild-type (wt)  2 . Mac-1 and LFA-1 expression with the mut-2  2 subunit were equivalent to results with wt  2 . Binding function of Mac-1 with mut-2  2 was equivalent to that with wt  2 . However, binding function of LFA-1 with the mut-2  2 subunit was reduced by 50% versus wt  2 . It was concluded that (1) the portion of the CD18 stalk region deleted in mut-1 is critical for  2 integrin heterodimer expression but the portion of the cytoplasmic domain truncated in mut-2 is not; and (2)
IntroductionImportant insights related to the molecular mechanisms that determine  2 integrin structure and function have arisen from the study of naturally occurring mutations in the common  2 subunit of this integrin family. 1,2 A range of mutations in the CD18 gene have been identified in patients with leukocyte adhesion deficiency type 1 (LAD-1), including deletions, truncations, substitutions, frame shifts, and intronic mutations that result in abnormalities of the CD18 protein ranging from absence of protein product, deficient alpha-beta subunit association, and reduced protein size. 1,3-5 All such mutations have resulted in diminished expression of the CD18 integrins on leukocytes, and some mutations also have caused integrin dysfunction. 1,[3][4][5] Patients typically have recurrent bacterial or fungal infections of skin and mucous membranes, impaired mobilization of leukocytes to sites of infection, severe gingivitis/ periodontitis with permanent loss of dentition, and atrophic scarring of wounds. 1,2,6 Laboratory features include a pronounced leukocytosis in the absence of infection, reduced expression of all members of the CD18 or  2 integrin family on circulating leukocytes, and diminished CD18-dependent leukocyte functions, including cell adhesion, chemotaxis, transendothelial migration, and oxidative burst activation in response to iC3b-coated particles. 1,2,6 We have identified an adult male patient with LAD-1 whose clinical features resemble those of the moderate LAD-1 phenotype, except that his wounds heal with hypertrophic rather than atrophic scarring. His levels of CD18 integrin expression are higher than those of most other reported patients with the moderate phenotype of LAD-1, but the CD18-dependent functions of his leukocytes were similar to those of other moderate phenotype individuals. 1,7 He was found to be a compound heterozygote with 2 novel m...