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| Primary immunodeficiency or monogenic inflammatory bowel disease v9.109 | BRAF | Isaac Machado Azevedo reviewed gene: BRAF: Rating: AMBER; Mode of pathogenicity: ; Publications: 40692796, 39372827, 36938251; Phenotypes: ; Mode of inheritance: MONOALLELIC, autosomal or pseudoautosomal, NOT imprinted | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Primary immunodeficiency or monogenic inflammatory bowel disease v9.108 | BRAF |
Achchuthan Shanmugasundram gene: BRAF was added gene: BRAF was added to Primary immunodeficiency or monogenic inflammatory bowel disease. Sources: Literature Mode of inheritance for gene: BRAF was set to MONOALLELIC, autosomal or pseudoautosomal, NOT imprinted |
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| Primary immunodeficiency or monogenic inflammatory bowel disease v9.80 | SH2B3 |
Achchuthan Shanmugasundram changed review comment from: PMID:23908464 (2013) reported two siblings from a consanguineous family of Eastern European Ashkenazi Jewish descent presenting with growth retardation, mild developmental delay, chronic hepatitis, and Hashimoto autoimmune thyroiditis. One of them (sister) developed B-precursor acute lymphoblastic leukemia (ALL). They were identified with germline homozygous frameshift variant in SH2B3 gene (c.671insGGCCCCG/ p. Asp231Gly fs*38). PMID:37206266 (2023) reported two further unrelated families with biallelic loss-of-function variants in SH2B3 gene (c.441_468del/ p.Arg148Profs*40 in patient 1 and c.1204G>A/ p.Val402Met in patient 2). These patients showed striking phenotypic similarity to each other as well as to the previous family from PMID:23908464 (2013) - presenting with myeloproliferation and multi-organ autoimmunity. One of these probands also suffered severe thrombotic complications. CRISPR-Cas9 gene editing of zebrafish sh2b3 created assorted deleterious variants in F0 crispants, which manifested significantly increased number of macrophages and thrombocytes, partially replicating the human phenotype. PMID:40481232 (2025) reported ten patients with Germline SH2B3 variants, which included biallelic variants in eight patients (homozygous in seven and compound heterozygous in one) and monoallelic variants in two. However, both patients with germline heterozygous variants had homozygous variants in hematopoietic cells. Of the ten patients, eight (six with biallelic and two with monoallelic germline variants) presented with a myeloproliferative disease characterized by leukocytosis with a leukoerythoblastic picture, low blast percentage in BM and splenomegaly, at birth or in the first months of life. Biallelic variants in this gene has not yet been associated with any relevant phenotypes in OMIM (last accessed 07 August 2026). This gene has been associated with Semidominant inheritance for SH2B3-related immune system disorder (MONDO:1060195) by Childhood, Adolescent and Young Adult Cancer Predisposition GCEP on ClinGen with 'Definitive' rating (https://search.clinicalgenome.org/CCID:009335).; to: PMID:23908464 (2013) reported two siblings from a consanguineous family of Eastern European Ashkenazi Jewish descent presenting with growth retardation, mild developmental delay, chronic hepatitis, and Hashimoto autoimmune thyroiditis. One of them (sister) developed B-precursor acute lymphoblastic leukemia (ALL). They were identified with germline homozygous frameshift variant in SH2B3 gene (c.671insGGCCCCG/ p. Asp231Gly fs*38). PMID:37206266 (2023) reported two further unrelated families with biallelic loss-of-function variants in SH2B3 gene (c.441_468del/ p.Arg148Profs*40 in patient 1 and c.1204G>A/ p.Val402Met in patient 2). These patients showed striking phenotypic similarity to each other as well as to the previous family from PMID:23908464 (2013) - presenting with myeloproliferation and multi-organ autoimmunity. One of these probands also suffered severe thrombotic complications. CRISPR-Cas9 gene editing of zebrafish sh2b3 created assorted deleterious variants in F0 crispants, which manifested significantly increased number of macrophages and thrombocytes, partially replicating the human phenotype. PMID:40481232 (2025) reported ten patients with germline SH2B3 variants, which included biallelic variants in eight patients (homozygous in seven and compound heterozygous in one) and monoallelic variants in two. However, both patients with germline heterozygous variants had homozygous variants in hematopoietic cells. Of the ten patients, eight (six with biallelic and two with monoallelic germline variants) presented with a myeloproliferative disease characterized by leukocytosis with a leukoerythoblastic picture, low blast percentage in BM and splenomegaly, at birth or in the first months of life. Biallelic variants in this gene has not yet been associated with any relevant phenotypes in OMIM (last accessed 07 August 2026). This gene has been associated with Semidominant inheritance for SH2B3-related immune system disorder (MONDO:1060195) by Childhood, Adolescent and Young Adult Cancer Predisposition GCEP on ClinGen with 'Definitive' rating (https://search.clinicalgenome.org/CCID:009335). |
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| Primary immunodeficiency or monogenic inflammatory bowel disease v9.44 | BIRC3 |
Achchuthan Shanmugasundram changed review comment from: PMID:42335979 (2026) reported the identification of rare and damaging BIRC3 variants in 14 patients from 10 unrelated families with Crohn's disease (CD) diagnosed between infancy and adulthood. They carried 8 distinct BIRC3 variants — 5 heterozygous missense/ nonsense variants (p.H312Y - recurrent in 2 families, p.T35A, p.P266R, p.C557X, p.D530H) causing pediatric- to adult-onset CD (age range <1 to 31 years), and 3 homozygous nonsense/ frameshift variants (p.Y522X, p.C588Y, p.X605Rext*10) in sibling pairs from consanguineous families, causing infantile-onset CD. Functional studies showed that BIRC3 (cIAP2) deficiency impairs RIPK1 ubiquitylation, causing RIPK1 autophosphorylation, resulting in increased epithelial cell death. Knock‑in cIAP2 (H312Y/+) mice and ciap1‑deficient zebrafish developed or exacerbated colitis, transcriptome analysis of mice organoids and zebrafish showed that BIRC3 deficiency led to inappropriate sustained activation of TNF‑responsive genes even without stimuli, and intestinal inflammation in BIRC3‑deficient models was attenuated by small‑molecule inhibition of RIPK1 or caspases. This gene has not yet been associated with relevant phenotypes in OMIM or ClinGen (last accessed 30 July 2026).; to: PMID:42335979 (2026) reported the identification of rare and damaging BIRC3 variants in 14 patients from 10 unrelated families with Crohn's disease (CD) diagnosed between infancy and adulthood. They carried 8 distinct BIRC3 variants — 5 heterozygous missense/ nonsense variants (p.H312Y - recurrent in 2 families and de novo in the index patient), p.T35A, p.P266R, p.C557X, p.D530H) causing pediatric- to adult-onset CD (age range <1 to 31 years), and 3 homozygous nonsense/ frameshift variants (p.Y522X, p.C588Y, p.X605Rext*10) in sibling pairs from consanguineous families, causing infantile-onset CD. Functional studies showed that BIRC3 (cIAP2) deficiency impairs RIPK1 ubiquitylation, causing RIPK1 autophosphorylation, resulting in increased epithelial cell death. Knock‑in cIAP2 (H312Y/+) mice and ciap1‑deficient zebrafish developed or exacerbated colitis, transcriptome analysis of mice organoids and zebrafish showed that BIRC3 deficiency led to inappropriate sustained activation of TNF‑responsive genes even without stimuli, and intestinal inflammation in BIRC3‑deficient models was attenuated by small‑molecule inhibition of RIPK1 or caspases. This gene has not yet been associated with relevant phenotypes in OMIM or ClinGen (last accessed 30 July 2026). |
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| Primary immunodeficiency or monogenic inflammatory bowel disease v9.16 | BIRC3 |
Boaz Palterer gene: BIRC3 was added gene: BIRC3 was added to Primary immunodeficiency or monogenic inflammatory bowel disease. Sources: Literature Mode of inheritance for gene: BIRC3 was set to BOTH monoallelic and biallelic (but BIALLELIC mutations cause a more SEVERE disease form), autosomal or pseudoautosomal Phenotypes for gene: BIRC3 were set to Inflammatory bowel disease; IBD; Crohn's disease Penetrance for gene: BIRC3 were set to unknown Review for gene: BIRC3 was set to GREEN Added comment: Qi Li et al. described 14 patients from 10 unrelated families with monoallelic and biallelic variants in BIRC3 presenting with CD. Biallelic variants present more severe and earlier. Extensive funtional validation including zebrafish and mice models, recapitulating phenotype https://www.gastrojournal.org/article/S0016-5085(26)06946-5/fulltext Sources: Literature |
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| Primary immunodeficiency or monogenic inflammatory bowel disease v9.9 | SH2B3 |
Boaz Palterer gene: SH2B3 was added gene: SH2B3 was added to Primary immunodeficiency or monogenic inflammatory bowel disease. Sources: Literature,Expert list Mode of inheritance for gene: SH2B3 was set to BIALLELIC, autosomal or pseudoautosomal Publications for gene: SH2B3 were set to 37206266 Phenotypes for gene: SH2B3 were set to Myeloproliferative disorder; Autoimmunity; Hepatosplenomegaly; Thrombosis; Autoimmune thyroiditis; Autoimmune hepatitis; Global developmental delay Penetrance for gene: SH2B3 were set to unknown Review for gene: SH2B3 was set to RED Added comment: Blombery et al. described 2 patients from 2 kindreds, harboring biallelic loss-of-function mutations in the SH2B3 gene. They presented with early-onset developmental delay, hepatosplenomegaly, multi-organ autoimmunity (including autoimmune thyroiditis and hepatitis), bone marrow myeloproliferation, and severe thrombotic complications. The underlying mechanism was validated ex vivo using patient-derived fibroblasts, demonstrating that upon stimulation with various cytokines (including IL-3, GH, GM-CSF, and EPO), the mutant cells exhibited significantly increased phosphorylation and hyperactivation of JAK2 and STAT5 signaling. The phenotype and mechanism were further validated in vivo using CRISPR-Cas9 engineered zebrafish animal models (sh2b3 F0 crispants). These models successfully recreated the myeloproliferative phenotype, presenting with a significantly increased number of macrophages and thrombocytes. Furthermore, rescue and treatment experiments demonstrated that administering the JAK1/2 inhibitor ruxolitinib to the mutant fish successfully intercepted and resolved the myeloproliferative defect. Sources: Literature, Expert list |
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| Primary immunodeficiency or monogenic inflammatory bowel disease v8.89 | BRF2 |
Ida Ertmanska gene: BRF2 was added gene: BRF2 was added to Primary immunodeficiency or monogenic inflammatory bowel disease. Sources: Literature Q1_26_promote_green tags were added to gene: BRF2. Mode of inheritance for gene: BRF2 was set to BIALLELIC, autosomal or pseudoautosomal Publications for gene: BRF2 were set to 40229899; 40781771 Review for gene: BRF2 was set to GREEN Added comment: PMID: 40229899 Mattioli et al., 2025 Report of six families (3 Icelandic, 1 Iranian, 1 Pakistani, 1 of unknown ancestry) with bi-allelic variants in BRF2 presenting with early mortality, brain, and craniofacial anomalies and/or neurodevelopmental disorders (NDD). Patients had phenotypes ranging from perinatal death to Treacher-Collins and craniosynostosis with radial defects and immunodeficiency or global developmental delay, hearing, and vision impairment. Families 1-3 = Icelandic families with founder BRF2 variant c.214 + 1G > A, not much detail provided on phenotype beyond "early lethality". Genotyping was not done for the affected fetuses, it was inferred from living family members. Family 4 - female proband with Treacher-Collins syndrome, presented with hearing impairment, soft cleft palate, microcephaly, and facial dysmorphism. She was homozygous for BRF2 c.481G > T; p.(Gly161*). Family 5 - 2 sibs compound het for BRF2 c.782C > T ; p.(Pro261Leu) & c.404_409delinsA; p.(Met135Asnfs*15); Patient II:1 female, presented with coronal synostosis, microcephaly, hypertelorism, a small beaked, nose, retrognathia, shortened right radius, and absent left radius, with radial deviation of the hands and contractures of all fingers. She was found to have anemia, leukocytosis, marked eosinophilia, and thrombocytopenia, and developed a significant rash by 1 month of age; she died at 2 mo from bacterial infection. Patient II:2, male - presented with frontal bone hypoplasia with bilateral coronal synostosis, micrognathia, small orbits, low-set ears, downward slanting palpebral fissures, and significantly decreased B-cell CD19 subsets. He subsequently developed ichthyosiform erythroderma and eosinophilic myeloid hyperplasia. He had developmental and speech delays. Family 6 - 4 affected sibs with moderate ID, and delays in motor and speech development; 2 sibs had mild hearing and vision impairment. 2 sibs confirmed homozygous for BRF2 c.31G > A; p.(Gly11Ser). Zebrafish knocked down for the orthologous brf2 presented with abnormal escape response, reduced swimming velocity and head size, and craniofacial malformations. Phenotype was rescued by human BRF2, but not by isoforms with patients variants. PMID: 40781771 Yoon et al., 2025 Case report - girl with multiple congenital anomalies: polydactyly of the right fifth toe, duplex kidney on the right side, hypodontia, and dysmorphic facial features. She had recurrent infections in the neonatal period, and was diagnosed with primary immunodeficiency at 4 months. Mild ID (IQ=60) was diagnosed at age 16 yrs. She harboured comp het BRF2 variants: c.379C>T, p.Arg127Ter & c.782C>T, p.Pro261Leu. Older sister was similarly affected; she died of infection at 19 months. Single-cell RNA-seq analysis of the patient sample revealed transcriptional abnormalities in PBMCs from the patient harboring BRF2 mutations. BRF2 mutations disrupt RNA Pol III activity specifically at type III promoters, leading to transcriptional dysregulation of critical noncoding RNAs Sources: Literature |
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| Primary immunodeficiency or monogenic inflammatory bowel disease v8.22 | DPP9 | Arina Puzriakova Added comment: Comment on list classification: There is sufficient evidence to promote this gene to Green at the next GMS panel update. Three unrelated families with four individuals with an immune disorder characterised by failure to thrive, skin manifestations, pancytopenia, recurrent fevers and recurrent infections. Supporting mouse and zebrafish models (PMID: 36112693) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Primary immunodeficiency or monogenic inflammatory bowel disease v4.6 | C2orf69 | Arina Puzriakova Added comment: Comment on list classification: New gene added to this panel by Boaz Palterer (University of Florence). Associated with a relevant phenotype in OMIM (MIM# 619423) but is not yet listed in G2P. At least 13 unrelated families reported in literature (PMIDs: 33945503; 34038740). Sufficient cases plus zebrafish model to promote this gene to green at the next GMS panel update. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Primary immunodeficiency or monogenic inflammatory bowel disease v2.434 | IPO8 |
Ivone Leong changed review comment from: Zornitza Stark also left a Green review of this gene on the Thoracic aortic aneurysm and dissection (Version 1.8): "12 individuals from 9 unrelated families in a cohort submitted for publication with bi-allelic IPO8 variants. Variants were nonsense/splice and some missense. Patients displayed a phenotype reminiscent of Loeys Dietz syndrome that variably combined cardiovascular, neurologic, skeletal and immunologic abnormalities along with dysmorphic features. Western blot on patient cells (4 individuals) showed reduced IPO8 expression. Disruption of IPO8 homologue in zebrafish associated with cardiac anomalies. Transcriptome analysis in zebrafish showed that IPO8-deficient zebrafish had abnormal TGFbeta pathway expression. Sources: Literature Zornitza Stark (Australian Genomics), 11 Jun 2021"; to: Zornitza Stark also left a Green review of this gene on the Thoracic aortic aneurysm and dissection (Version 1.8) panel: "12 individuals from 9 unrelated families in a cohort submitted for publication with bi-allelic IPO8 variants. Variants were nonsense/splice and some missense. Patients displayed a phenotype reminiscent of Loeys Dietz syndrome that variably combined cardiovascular, neurologic, skeletal and immunologic abnormalities along with dysmorphic features. Western blot on patient cells (4 individuals) showed reduced IPO8 expression. Disruption of IPO8 homologue in zebrafish associated with cardiac anomalies. Transcriptome analysis in zebrafish showed that IPO8-deficient zebrafish had abnormal TGFbeta pathway expression. Sources: Literature Zornitza Stark (Australian Genomics), 11 Jun 2021" |
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| Primary immunodeficiency or monogenic inflammatory bowel disease v2.434 | IPO8 |
Ivone Leong commented on gene: IPO8: Zornitza Stark also left a Green review of this gene on the Thoracic aortic aneurysm and dissection (Version 1.8): "12 individuals from 9 unrelated families in a cohort submitted for publication with bi-allelic IPO8 variants. Variants were nonsense/splice and some missense. Patients displayed a phenotype reminiscent of Loeys Dietz syndrome that variably combined cardiovascular, neurologic, skeletal and immunologic abnormalities along with dysmorphic features. Western blot on patient cells (4 individuals) showed reduced IPO8 expression. Disruption of IPO8 homologue in zebrafish associated with cardiac anomalies. Transcriptome analysis in zebrafish showed that IPO8-deficient zebrafish had abnormal TGFbeta pathway expression. Sources: Literature Zornitza Stark (Australian Genomics), 11 Jun 2021" |
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| Primary immunodeficiency or monogenic inflammatory bowel disease v2.421 | IPO8 |
Boaz Palterer gene: IPO8 was added gene: IPO8 was added to Primary immunodeficiency. Sources: Literature Mode of inheritance for gene: IPO8 was set to BIALLELIC, autosomal or pseudoautosomal Publications for gene: IPO8 were set to 34010604 Phenotypes for gene: IPO8 were set to cardiovascular anomalies; joint hyperlaxity; dysmorphic features; developmental delay; immune dysregulation; allergy Penetrance for gene: IPO8 were set to unknown Review for gene: IPO8 was set to GREEN Added comment: Ziegler et al. reported 12 individuals from 9 unrelated kindreds with bi-allelic loss-of-function variants in IPO8 presenting with a syndromic association characterized by cardio-vascular anomalies, joint hyperlaxity, and various degree of dysmorphic features and developmental delay as well as immune dysregulation. IPO8 is involved in the TGFbeta/SMAD signaling, which is a known pathway in Loeys-Dietz syndrome. Functional data in a zebrafish model. Sources: Literature |
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| Primary immunodeficiency or monogenic inflammatory bowel disease v2.124 | BCL11B |
Eleanor Williams changed review comment from: Associated with Immunodeficiency 49 #617237 (AD) in OMIM. PMID: 29985992 - Lessel et al 2018 - identified de novo heterozygous germline mutations in BCL11B in nine unrelated patients, namely six frameshift, two nonsense and one missense mutation. A further patient inherited a heterozygous frameshift mutation, p.(Asp534Thrfs*29), transmitted from an affected mother with. All analysed individuals exhibited developmental delay and intellectual disability and a severe reduction of peripheral ILC2s and impaired T cell development, but no overt immune deficiency. Patient E:II-1 was the only patient with suspected immunodeficiency diagnosed upon newborn screening. Other de-novo variants were also detected in some patients. PMID: 27959755 - Punwani et al 2016 - an infant with "leaky" SCID as well as craniofacial and dermal abnormalities and the absence of a corpus callosum. Exome sequencing revealed a heterozygous de novo missense mutation, p.N441K, in BCL11B. The mutant protein had dominant negative activity, which prevented the wild-type BCL11B to bind DNA, thereby arresting development of the T-cell lineage and disrupting hematopoietic stem-cell migration. bcl11ba-deficient zebrafish recapitulated the phenotype.; to: Associated with Immunodeficiency 49 #617237 (AD) in OMIM. PMID: 29985992 - Lessel et al 2018 - identified de novo heterozygous germline mutations in BCL11B in nine unrelated patients, namely six frameshift, two nonsense and one missense mutation. A further patient inherited a heterozygous frameshift mutation, p.(Asp534Thrfs*29), transmitted from an affected mother with. All analysed individuals exhibited developmental delay and intellectual disability and a severe reduction of peripheral ILC2s and impaired T cell development, but no overt immune deficiency. Patient E:II-1, with a missense variant, was the only patient with suspected immunodeficiency diagnosed upon newborn screening. Other de-novo variants were also detected in some patients. PMID: 27959755 - Punwani et al 2016 - an infant with "leaky" SCID as well as craniofacial and dermal abnormalities and the absence of a corpus callosum. Exome sequencing revealed a heterozygous de novo missense mutation, p.N441K, in BCL11B. The mutant protein had dominant negative activity, which prevented the wild-type BCL11B to bind DNA, thereby arresting development of the T-cell lineage and disrupting hematopoietic stem-cell migration. bcl11ba-deficient zebrafish recapitulated the phenotype. |
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