Browsing by Author "Reinke, Julia G."

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    Genetically programmed alternative splicing of NEMO mediates an autoinflammatory disease phenotype
    (The American Society for Clinical Investigation, 2022) Lee, Younglang; Wessel, Alex W.; Xu, Jiazhi; Reinke, Julia G.; Lee, Eries; Kim, Somin M.; Hsu, Amy P.; Zilberman-Rudenko, Jevgenia; Cao, Sha; Enos, Clinton; Brooks, Stephen R.; Deng, Zuoming; Lin, Bin; de Jesus, Adriana A.; Hupalo, Daniel N.; Piotto, Daniela G.P.; Terreri, Maria T.; Dimitriades, Victoria R.; Dalgard, Clifton L.; Holland, Steven M.; Goldbach-Mansky, Raphaela; Siegel, Richard M.; Hanson, Eric P.; Pediatrics, School of Medicine
    Host defense and inflammation are regulated by the NF-κB essential modulator (NEMO), a scaffolding protein with a broad immune cell and tissue expression profile. Hypomorphic mutations in inhibitor of NF-κB kinase regulatory subunit gamma (IKBKG) encoding NEMO typically present with immunodeficiency. Here, we characterized a pediatric autoinflammatory syndrome in 3 unrelated male patients with distinct X-linked IKBKG germline mutations that led to overexpression of a NEMO protein isoform lacking the domain encoded by exon 5 (NEMO-Δex5). This isoform failed to associate with TANK binding kinase 1 (TBK1), and dermal fibroblasts from affected patients activated NF-κB in response to TNF but not TLR3 or RIG-I-like receptor (RLR) stimulation when isoform levels were high. By contrast, T cells, monocytes, and macrophages that expressed NEMO-Δex5 exhibited increased NF-κB activation and IFN production, and blood cells from these patients expressed a strong IFN and NF-κB transcriptional signature. Immune cells and TNF-stimulated dermal fibroblasts upregulated the inducible IKK protein (IKKi) that was stabilized by NEMO-Δex5, promoting type I IFN induction and antiviral responses. These data revealed how IKBKG mutations that lead to alternative splicing of skipping exon 5 cause a clinical phenotype we have named NEMO deleted exon 5 autoinflammatory syndrome (NDAS), distinct from the immune deficiency syndrome resulting from loss-of-function IKBKG mutations.