Primary immunodeficiency or monogenic inflammatory bowel disease

Gene: KMT2D

The rating of this gene has been updated following NHS Genomic Medicine Service approval.

Created: 8 Mar 2022, 10:59 a.m. | Last Modified: 8 Mar 2022, 10:59 a.m.

Panel Version: 2.532

Comment on list classification: Immunopathological manifestations are seen in ~50% of cases with KMT2D-related Kabuki syndrome. There is sufficient evidence to support this gene-disease association and therefore this gene should be promoted to Green status at the next GMS panel update.

Created: 14 Sep 2021, 12:46 p.m. | Last Modified: 14 Sep 2021, 12:46 p.m.

Panel Version: 2.464

Green List (high evidence)

Immunodeficiency is a well-known and common feature of KS. Recent study shows:
"Overall, 44.1% (78/177) and 58.2% (46/79) of KS individuals exhibited infection susceptibility and hypogammaglobulinemia, respectively"

Created: 12 Sep 2021, 11:06 a.m. | Last Modified: 12 Sep 2021, 11:06 a.m.

Panel Version: 2.458

Phenotypes
Hypogammaglobulinemia; intellectual disability; short stature

Publications

• PMID: 31363182

The following PubMed IDs were added to gene KMT2D (OMIM gene MIM#602113): 23913813;21671394;21607748. These publications have been associated with the gene by the immunodeficiencies subgroup of the Human Phenotype Ontology Immune Mediated Disorders Consortium (https://hpo-immune-mediated-disorders.groups.io/g/update) in August 2020.

Created: 13 Oct 2020, 9:36 a.m. | Last Modified: 13 Oct 2020, 9:36 a.m.

Panel Version: 2.208

Publications

• 23913813
• 21671394
• 21607748

Comment on publications: Comment on publications: Added publications to support immunodeficiency phenotype and KS. Stagi S et al. (2016) PMID: 26411453 noted that most KS patients show increased susceptibility to infections and have reduced serum immunoglobulin levels, while some suffer also from autoimmune manifestations, such as idiopathic thrombocytopenic purpura, hemolytic anemia, autoimmune thyroiditis, and vitiligo. They reviewed the immunological aspects of KS and proposed a novel model to account for the immune dysfunction observed in this condition.

Created: 6 Jul 2018, 2:38 p.m.

Comment on publications: Comment on publications: Immunological abnormalities and KS were systematically analyzed for the first time in 2005, Hoffman JD et al. (2005) PMID:15887282. Although it was noted that no studies have analyzed in detail the functional consequences of KMT2D and KDM6A mutations on the immune system of patients with KS, and no mechanistic models accounting for such abnormalities have been proposed. Low serum immunoglobulin levels and reduced memory T and B lymphocytes have been reported Lin JL et al. (2015) PMID:25142838. Also increased occurrence of autoimmune manifestations, such as idiopathic thrombocytopenic purpura (ITP), hemolytic anemia, autoimmune thyroiditis, and vitiligo has been reported by Ming JE et al. (2005) PMID:15523604, suggests that both KMT2D and KDM6A genes may play a relevant, still undisclosed, role in the immune homeostasis.

Created: 6 Jul 2018, 2:37 p.m.

OriginaI Metadata from IUIS classification table (February, 2018) downloaded 20180614. IUIS Genetic defect (original gene symbol in IUIS download): KMT2D (MLL2) .PanelApp HGNC gene symbol check: KMT2D . IUIS Disease: Kabuki Syndrome 1 due to KMT2D deficiency . IUIS Inheritance: AD .T cells: Nl number, defective migration, proliferaton, .B cells: Normal, .IUIS Other affected cells: N/A. IUIS Associated features: Typical facial abnormalities, cleft or high arched palate, skeletal abnormalities, short stature, intellectual disability, congenital heart defects, recurrent infections (otitis media, pneumonia) in 50% of patients. Autoimmunity may be present. IUIS Major category: Combined immunodeficiencies with associated or syndromic features. IUIS Subcategory: Other Combined immunodeficiencies with associated or syndromic features

Created: 6 Jul 2018, 12:29 p.m.

Red List (low evidence)

Immunodeficiency not a prominent feature

Created: 29 Jun 2018, 9:39 p.m.

Mode of inheritance
MONOALLELIC, autosomal or pseudoautosomal, imprinted status unknown

Phenotypes
Kabuki syndrome 1