Yonsei Med J.  2018 Oct;59(8):1004-1007. 10.3349/ymj.2018.59.8.1004.

Bronchiectasis and Recurrent Respiratory Infections with a De Novo STAT1 Gain-of-Function Variant: First Case in Korea

Affiliations
  • 1Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 2Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. wjkoh@skku.edu
  • 3Division of Pediatric Infectious Diseases and Immunodeficiency, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 4Center for Clinical Medicine, Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Korea.
  • 5Green Cross Genome, Yongin, Korea. changski.md@gmail.com

Abstract

Bronchiectasis is a chronic disease characterized by airway infection and inflammation, leading to permanent dilation of the bronchi. Evaluation of underlying etiology is important in managing young bronchiectasis patients with recurrent infections caused by unusual pathogens. The signal transducer and activator of transcription 1 (STAT1) protein plays a key role in STAT signaling and immune system regulation. Heterozygotes for gain-of-function (GOF) alleles of the STAT1 gene usually display autosomal dominant chronic mucocutaneous candidiasis (CMC) and a wide range of clinical features, such as bronchiectasis. Here, we report on a patient with CMC and bronchiectasis with various types of infections who carried a pathogenic variant of the STAT1 gene. The 24-year-old female presented with recurrent respiratory bacterial and nontuberculous mycobacterial infections complicated by severe bronchiectasis and CMC. Whole-exome sequencing revealed a c.800C>T (p.Ala267Val) heterozygous mutation in the STAT1 gene. Further analysis by Sanger sequencing of STAT1 from the patient and her parents revealed the patient had a de novo occurrence of the variant. This is the first report of a Korean patient with a GOF pathogenic variant in STAT1. Physicians should be aware of the existence of this variant as a genetic factor associated with CMC and bronchiectasis complicated by recurrent infection.

Keyword

Bronchiectasis; chronic mucocutaneous candidiasis; gain-of-function mutation; nontuberculous mycobacteria; STAT1 transcription factor

MeSH Terms

Alleles
Bronchi
Bronchiectasis*
Candidiasis, Chronic Mucocutaneous
Chronic Disease
Female
Heterozygote
Humans
Immune System
Inflammation
Korea*
Nontuberculous Mycobacteria
Parents
Respiratory Tract Infections*
STAT1 Transcription Factor
Young Adult
STAT1 Transcription Factor

Figure

  • Fig. 1 Fungal infections and severe bronchiectasis in the 24-year-old female patient. (A) Cutaneous candidiasis of nasal skin. (B) Onychomycosis of a fingernail. (C) Bilateral bronchiectasis and bronchiolitis on chest computed tomography scan.

  • Fig. 2 Pathogenic STAT1 variant identified in the 24-year-old female patient. (A) Integrative Genomics Viewer snapshot of the STAT1 pathogenic variant (NM_007315.3:c.800C>T, p.Ala267Val) (arrow) identified by whole-exome sequencing. (B) Validation of the STAT1 variant by Sanger sequencing. Chromatograms show the heterozygous variant in the proband (patient), indicated by the arrow, and the normal sequence in the unaffected parents.


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