Inherited human OX40 deficiency underlying classic Kaposi sarcoma of childhood

J Exp Med. 2013 Aug 26;210(9):1743-59. doi: 10.1084/jem.20130592. Epub 2013 Jul 29.


Kaposi sarcoma (KS), a human herpes virus 8 (HHV-8; also called KSHV)-induced endothelial tumor, develops only in a small fraction of individuals infected with HHV-8. We hypothesized that inborn errors of immunity to HHV-8 might underlie the exceedingly rare development of classic KS in childhood. We report here autosomal recessive OX40 deficiency in an otherwise healthy adult with childhood-onset classic KS. OX40 is a co-stimulatory receptor expressed on activated T cells. Its ligand, OX40L, is expressed on various cell types, including endothelial cells. We found OX40L was abundantly expressed in KS lesions. The mutant OX40 protein was poorly expressed on the cell surface and failed to bind OX40L, resulting in complete functional OX40 deficiency. The patient had a low proportion of effector memory CD4(+) T cells in the peripheral blood, consistent with impaired CD4(+) T cell responses to recall antigens in vitro. The proportion of effector memory CD8(+) T cells was less diminished. The proportion of circulating memory B cells was low, but the antibody response in vivo was intact, including the response to a vaccine boost. Together, these findings suggest that human OX40 is necessary for robust CD4(+) T cell memory and confers apparently selective protective immunity against HHV-8 infection in endothelial cells.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age of Onset
  • Amino Acid Sequence
  • Amino Acid Substitution / genetics
  • Antibody Formation / immunology
  • Base Sequence
  • Cell Membrane / metabolism
  • Child
  • Cysteine / genetics
  • Female
  • HEK293 Cells
  • Homozygote
  • Humans
  • Immunologic Memory / immunology
  • Inheritance Patterns / genetics*
  • Intracellular Space / metabolism
  • Lymphocyte Count
  • Molecular Sequence Data
  • Mutant Proteins / chemistry
  • Mutant Proteins / metabolism
  • Mutation / genetics
  • Receptors, OX40 / chemistry
  • Receptors, OX40 / deficiency*
  • Receptors, OX40 / genetics*
  • Receptors, OX40 / metabolism
  • Sarcoma, Kaposi / blood
  • Sarcoma, Kaposi / genetics*
  • Sarcoma, Kaposi / immunology
  • Sarcoma, Kaposi / pathology
  • T-Lymphocyte Subsets / metabolism
  • Young Adult


  • Mutant Proteins
  • Receptors, OX40
  • Cysteine