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Primary Immunodeficiencies Worldwide

Case Report ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Immunol. | doi: 10.3389/fimmu.2018.00420


  • 1School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia


We investigated the molecular aetiology of a young male proband with confirmed immunodeficiency of unknown cause, presenting with recurrent bacterial and Varicella zoster viral infections in childhood and persistent lymphopaenia into early adulthood.


To identify causative functional genetic variants related to an undiagnosed primary immunodeficiency.


Whole genome microarray copy number variant (CNV) analysis was performed on the proband followed by whole exome sequencing (WES) and trio analysis of the proband and family members. A >4kbp deletion identified by repeated CNV analysis of exome sequencing data along with three damaging missense single nucleotide variants were validated by Sanger sequencing in all family members. Confirmation of the causative role of the candidate gene was performed by qPCR and Western Blot analyses on the proband, family members and a healthy control.


CNV identified our previously reported IL25 amplification in the proband, however the variant was not validated to be a candidate gene for immunodeficiency. WES trio analysis, data filtering and in-silico prediction identified a novel, damaging (SIFT: 0; Polyphen 1; Grantham score: 101) and disease-causing (MutationTaster) single base mutation in the X chromosome (c.511C>T p.Arg171Trp) MSN gene not identified in the UCSC Genome Browser database. The mutation was validated by Sanger sequencing, confirming the proband was hemizygous X-linked recessive (-/T) at this locus and inherited the affected T allele from his non-symptomatic carrier mother (C/T), with other family members (father, sister) confirmed to be wild type (C/C). Western Blot analysis demonstrated an absence of moesin protein in lymphocytes derived from the proband, compared with normal expression in lymphocytes derived from the healthy control, father and mother. qPCR identified significantly lower MSN mRNA transcript expression in the proband compared to an age- and sex-matched healthy control subject in whole blood (P = 0.02), and lymphocytes (P = 0.01). These results confirmed moesin deficiency in the proband, directly causative of his immunodeficient phenotype.


These findings confirm X-linked moesin-associated immunodeficiency in a proband previously undiagnosed up to 24 years of age. This study also highlights the utility of WES for the diagnosis of rare or novel forms of primary immunodeficiency disease.

Keywords: Lymphopaenia, whole exome sequencing, moesin, MSN, X-linked moesin-associated immunodeficiency, X-MAID

Received: 01 Dec 2017; Accepted: 15 Feb 2018.

Edited by:

Antonio Condino-Neto, University of São Paulo, Brazil

Reviewed by:

Ivan K. Chinn, Baylor College of Medicine, United States
Michel Massaad, American University of Beirut Medical Center, Lebanon  

Copyright: © 2018 Bradshaw, Lualhati, Albury, Maksemous, Roos-Araujo, Smith, Benton, Eccles, Lea, Sutherland, Haupt and Griffiths. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Lyn R. Griffiths, Queensland University of Technology, School of Biomedical Sciences, Institute of Health and Biomedical Innovation, 60 Musk Avenue, Kelvin Grove, Brisbane, 4059, Queensland, Australia,