Spectrum of perforin gene mutations in familial hemophagocytic lymphohistiocytosis

K. G. Ericson, B. Fadeel, S. Nilsson-Ardnor, C. Söderhäll, A. Samuelsson, G. Janka, M. Schneider, A. Gürgey, N. Yalman, T. Révész, R. M. Egeler, K. Jahnukainen, I. Storm-Mathiesen, A. Haraldsson, J. Poole, G. De Saint Basile, M. Nordenskjöld, J. I. Henter

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Familial hemophagocytic lymphohistiocytosis (FHL) is an autosomal recessive disease of early childhood characterized by nonmalignant accumulation and multivisceral infiltration of activated T lymphocytes and histiocytes (macrophages). Cytotoxic T and natural killer (NK) cell activity is markedly reduced or absent in these patients, and mutations in a lytic granule constituent, perforin, were recently identified in a number of FHL individuals. Here, we report a comprehensive survey of 34 additional patients with FHL for mutations in the coding region of the perforin gene and the relative frequency of perforin mutations in FHL. Perforin mutations were identified in 7 of the 34 families investigated. Six children were homozygous for the mutations, and one patient was a compound heterozygote. Four novel mutations were detected: one nonsense, two missense, and one deletion of one amino acid. In four families, a previously reported mutation at codon 374, causing a premature stop codon, was identified, and, therefore, this is the most common perforin mutation identified so far in FHL patients. We found perforin mutations in 20% of all FHL patients investigated (7/34), with a somewhat higher prevalence, ∼30% (6/20), in children whose parents originated from Turkey. No other correlation between the type of mutation and the phenotype of the patients was evident from the present study. Our combined results from mutational analysis of 34 families and linkage analysis of a subset of consanguineous families indicate that perforin mutations account for 20%-40% of the FHL cases and the FHL 1 locus on chromosome 9 for ∼10%, whereas the major part of the FHL cases are caused by mutations in not-yet-identified genes.

Original languageEnglish
Pages (from-to)590-597
Number of pages8
JournalAmerican Journal of Human Genetics
Issue number3
Publication statusPublished - 2001

Bibliographical note

Funding Information:
We thank all patients and their families participating in the study for their cooperation and Ulla Grandell and Teresia Pettersson for technical assistance. Presented in part at the Annual Meeting of the Histiocyte Society in Amsterdam, October 2000. This study was supported by the Children's Cancer Foundation of Sweden, the Swedish Medical Research Council, the Swedish Cancer Society, the Märta and Gunnar V. Philipson Foundation, the Ronald McDonald Foundation, and the Histiocytosis Association of America.


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