
Reticular dysgenesis is a form of severe combined immunodeficiency (SCID) caused by biallelic pathogenic variants in AK2. Here we present the case of a boy diagnosed with SCID following a positive newborn screen (NBS). Genetic testing revealed a homozygous variant: AK2 c.330 + 5G > A. In silico analyses predicted weakened native donor splice site. However, this variant was initially classified as a variant of uncertain significance (VUS) given lack of direct evidence. To determine the impact on splicing, we analyzed RNA from the proband and his parents, using massively parallel RNA-seq of cloned RT-PCR products. Analysis showed that c.330 + 5G > A results in exon 3 skipping, which encodes a critical region of the AK2 protein. With these results, the variant was upgraded to pathogenic, and the patient was given a diagnosis of reticular dysgenesis. Interpretation of VUS at noncanonical splice site nucleotides presents a challenge. RNA sequencing provides an ideal platform to perform qualitative and quantitative assessment of intronic VUS, which can lead to reclassification if a significant impact on mRNA is observed. Genetic disorders of hematopoiesis and immunity represent fruitful areas to apply RNA-based analysis for variant interpretation given the high expression of RNA in blood.
Male, Peripheral Blood Stem Cell Transplantation, RNA Splicing, Adenylate Kinase, DNA Mutational Analysis, Infant, Newborn, Genetic Variation, Infant, Research Reports, Exons, Leukopenia, Introns, Phenotype, Treatment Outcome, Mutation, Humans, Genetic Predisposition to Disease, Severe Combined Immunodeficiency, Alleles, Genetic Association Studies
Male, Peripheral Blood Stem Cell Transplantation, RNA Splicing, Adenylate Kinase, DNA Mutational Analysis, Infant, Newborn, Genetic Variation, Infant, Research Reports, Exons, Leukopenia, Introns, Phenotype, Treatment Outcome, Mutation, Humans, Genetic Predisposition to Disease, Severe Combined Immunodeficiency, Alleles, Genetic Association Studies
| selected citations These citations are derived from selected sources. This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically). | 5 | |
| popularity This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network. | Top 10% | |
| influence This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically). | Average | |
| impulse This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network. | Top 10% |
