LIG4 Syndrome: Clinical and Molecular Characterization in a Chinese Cohort
Abstract Background: DNA Ligase IV (LIG4) syndrome is a rare disease with few reports to date. Patients suffer from a broad spectrum of clinical features, including microcephaly, growth retardation, developmental delay, dysmorphic facial features, combined immunodeficiency, and malignancy predisposition. There is thought to be a potential association between genotypes and phenotypes. Here, we investigated the characteristics of LIG4 syndrome in a Chinese cohort.Results: All seven patients had growth restriction. Most patients (6/7) had microcephaly (< -3 SD). Recurrent bacterial infections of the lungs and intestines were the most common symptoms. One patient had myelodysplastic syndromes. One patient presented with an inflammatory bowel disease (IBD)-like phenotype. Patients presented with combined immunodeficiency. The proportions of naive CD4+ and naive CD8+ T cells decreased notably in five patients. All patients harbored compound heterozygous mutations in the LIG4 gene, consisting of a missense mutation (c.833G>T, p.R278L) and a deletion shift mutation, primarily c.1271-1275delAAAGA (p.K424Rfs). Two other deletion mutations, c.1144-1145delCT and c.1277-1278delAA, were novel. Patients with p.K424RfsX20/p.R278 might lead to milder dysmorphism, but more significant IgA/ IgM deficiency, compared with the frequent genotype p.R814X/p.K424RfsX20 reported. One patient underwent umbilical cord blood stem cell transplantation (UCBSCT) but died.Conclusions: This study reported the clinical and molecular characteristics of a Chinese cohort, further expanding the phenotypic and genotypic spectrum, and the understanding of genotype-to-phenotype correlations in LIG4 syndrome. The results may help to characterize the status of the disease in China.