Article
作者: Notarangelo, Luigi D. ; Uzel, Gulbu ; Nevalainen, Pasi I. ; Oler, Andrew J. ; Hsu, Amy P. ; Gandhi, Bhumika ; Schussler, Edith ; Rubinstein, Arye ; Ferré, Elise M. N. ; Schmitt, Monica M. ; Barber, Princess ; Walkiewicz, Magdalena ; Winer, Karen K. ; Auwaerter, Paul G. ; Lionakis, Michail S. ; Shashi, Vandana ; Zhou, Qing ; Heller, Theo ; Seppänen, Mikko R. J. ; Franco, Luis M. ; van Hamburg, Jan Piet ; Dalgard, Cliffton L. ; Rosen, Lindsey B. ; van Laar, Gustaaf G. ; Laakso, Saila ; Neth, Olaf ; Afzali, Behdad ; Tas, Sander W. ; Miller, Jennifer L. ; Olbrich, Peter ; Oikonomou, Vasileios ; Balliu, Erjola ; Seifert, Bryce A. ; Holland, Steven M. ; Perera, Lalith ; Kumar, Dhaneshwar ; DiMaggio, Tom ; Chauss, Daniel ; Grönholm, Juha ; Askentijevich, Ivona ; Ganesan, Sundar ; Constantine, Gregory M. ; Le, Kim My ; Mamia, Nanni ; Gahl, William ; Ghosh, Rajarshi ; Eisenberg, Rachel ; Boon, Louis ; Ochoa, Sebastian
Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is a life-threatening monogenic autoimmune disorder primarily caused by biallelic deleterious variants in the autoimmune regulator (
AIRE
) gene. We prospectively evaluated 104 patients with clinically diagnosed APECED syndrome and identified 17 patients (16%) from 14 kindreds lacking biallelic
AIRE
variants in exons or flanking intronic regions; 15 had Puerto Rican ancestry. Through whole-genome sequencing, we identified a deep intronic
AIRE
variant (c.1504-818 G>A) cosegregating with the disease in all 17 patients. We developed a culture system of
AIRE
-expressing primary patient monocyte-derived dendric cells and demonstrated that c.1504-818 G>A creates a cryptic splice site and activates inclusion of a 109–base pair frame-shifting pseudoexon. We also found low-level
AIRE
expression in patient-derived lymphoblastoid cell lines (LCLs) and confirmed pseudoexon inclusion in independent extrathymic
AIRE
–expressing cell lines. Through protein modeling and transcriptomic analyses of
AIRE
-transfected human embryonic kidney 293 and thymic epithelial cell 4D6 cells, we showed that this variant alters the carboxyl terminus of the AIRE protein, abrogating its function. Last, we developed an antisense oligonucleotide (ASO) that reversed pseudoexon inclusion and restored the normal
AIRE
transcript sequence in LCLs. Thus, our findings revealed c.1504-818 G>A as a founder APECED-causing
AIRE
variant in the Puerto Rican population and uncovered pseudoexon inclusion as an ASO-reversible genetic mechanism underlying APECED.