Severe Combined Immunodeficiency Resulting From Mutations in MTHFD1
Folate and vitamin B12 metabolism are essential for de novo purine synthesis, and several defects in these pathways have been associated with immunodeficiency. Here we describe the occurrence of severe combined immunodeficiency (SCID) with megaloblastic anemia, leukopenia, atypical hemolytic uremic syndrome, and neurologic abnormalities in which hydroxocobalamin and folate therapy provided partial immune reconstitution. Whole exome sequencing identified compound heterozygous mutations in the MTHFD1 gene, which encodes a trifunctional protein essential for processing of single-carbon folate derivatives. We now report the immunologic details of this novel genetic cause of SCID and the response to targeted metabolic supplementation therapies. This finding expands the known metabolic causes of SCID and presents an important diagnostic consideration given the positive impact of therapy.
- ADA —
- adenosine deaminase
- HUS —
- hemolytic-uremic syndrome
- Ig —
- PCFT —
- proton-coupled folate transporter
- PNP —
- purine nucleoside phosphorylase
- SCID —
- severe combined immunodeficiency
- Accepted September 11, 2012.
- Copyright © 2013 by the American Academy of Pediatrics