Key Points• IRF8 K108E mutation causes dendritic cell depletion, defective antigen presentation, and anergic T cells.• IRF8 K108E mutant protein is functionally null and shows defective nuclear targeting and increased proteasomal degradation.We have previously reported on a unique patient in whom homozygosity for a mutation at IRF8 (IRF8 K108E ) causes a severe immunodeficiency. Laboratory evaluation revealed a highly unusual myeloid compartment, remarkable for the complete absence of CD14 1 and CD161 monocytes, absence of CD11c 1 conventional dendritic cells (DCs) and CD11c 1 /CD123 1 plasmacytoid DCs, and striking granulocytic hyperplasia. The patient initially presented with severe disseminated mycobacterial and mucocutaneous fungal infections and was ultimately cured by cord blood transplant. Sequencing RNA from the IRF8 K108E patient's primary blood cells prior to transplant shows not only depletion of IRF8-bound and IRF8-regulated transcriptional targets, in keeping with the distorted composition of the myeloid compartment, but also a paucity of transcripts associated with activated CD4 1 and CD8 1 T lymphocytes. This suggests that T cells reared in the absence of a functional antigen-presenting compartment in IRF8 K108E are anergic.Biochemical characterization of the IRF8 K108E mutant in vitro shows that loss of the positively charged side chain at K108 causes loss of nuclear localization and loss of transcriptional activity, which is concomitant with decreased protein stability, increased ubiquitination, increased small ubiquitin-like modification, and enhanced proteasomal degradation. These findings provide functional insight into the molecular basis of immunodeficiency associated with loss of IRF8. (Blood. 2014;124(12):1894-1904
IntroductionPrimary immunodeficiencies sometimes present with disseminated mycobacterial infection following neonatal vaccination with live Bacillus Calmette-Guérin (BCG). 1 In many cases, patients suffer from Mendelian susceptibility to mycobacterial disease, a syndrome caused by infection with weakly virulent mycobacteria such as BCG, with environmental mycobacteria, and/or recurrent infections with virulent mycobacteria (Mycobacterium tuberculosis) over the life course.2 Approximately half of patients with Mendelian susceptibility to mycobacterial disease have been shown to carry mutations in a small subset of genes involved in interferon (IFN) g-dependent early immune responses. 2,3 Other patients develop disseminated BCG disease as part of a broader pattern of susceptibility to infection (eg, severe combined immunodeficiency).We have previously reported an infant presenting with severe disseminated BCG infection, oral candidiasis, and severe respiratory viral infection. 4 Evaluation of the patient's blood cellular profile revealed an aberrant myeloid compartment; notably, a complete absence of CD14 1 and CD16 1 monocytes, absence of CD11c DCs, and prominent granulocytic hyperplasia. 4 The peripheral blood B-lymphocyte count was also increased in this patient. Production o...