Successful Hematopoietic Stem Cell Transplantation in a Patient with LPS-Responsive Beige-Like Anchor (LRBA) Gene Mutation

J Clin Immunol. 2016 Jul;36(5):480-9. doi: 10.1007/s10875-016-0289-y. Epub 2016 May 4.


Purpose: Autosomal recessive mutations in LRBA, encoding for LPS-responsive beige-like anchor protein, were described in patients with a common variable immunodeficiency (CVID)-like disease characterized by hypogammaglobulinemia, autoimmune cytopenias, and enteropathy. Here, we detail the clinical, immunological, and genetic features of a patient with severe autoimmune manifestations.

Methods: Whole exome sequencing was performed to establish a molecular diagnosis. Evaluation of lymphocyte subsets was performed for immunological characterization. Medical files were reviewed to collect clinical and immunological data.

Results: A 7-year-old boy, born to consanguineous parents, presented with autoimmune hemolytic anemia, hepatosplenomegaly, autoimmune thyroiditis, and severe autoimmune gastrointestinal manifestations. Immunological investigations revealed low immunoglobulin levels and low numbers of B and NK cells. Treatment included immunoglobulin replacement and immunosuppressive therapy. Seven years after disease onset, the patient developed severe neurological symptoms resembling acute disseminated encephalomyelitis, prompting allogeneic hematopoietic stem cell transplantation (HSCT) with the HLA-identical mother as donor. Whole exome sequencing of the patient uncovered a homozygous 1 bp deletion in LRBA (c.7162delA:p.T2388Pfs*7). Importantly, during 2 years of follow-up post-HSCT, marked clinical improvement and recovery of immune function was observed.

Conclusions: Our data suggest a beneficial effect of HSCT in patients with LRBA deficiency.

Keywords: acute disseminated encephalomyelitis; common variable immune deficiency; enteropathy; hematopoietic stem cell transplantation; primary immunodeficiency; whole exome sequencing.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptor Proteins, Signal Transducing / genetics*
  • Anemia, Hemolytic, Autoimmune / diagnosis
  • Anemia, Hemolytic, Autoimmune / genetics
  • Anemia, Hemolytic, Autoimmune / therapy*
  • Autoimmunity
  • B-Lymphocytes / immunology*
  • Child
  • Common Variable Immunodeficiency / diagnosis
  • Common Variable Immunodeficiency / genetics
  • Common Variable Immunodeficiency / therapy*
  • Consanguinity
  • DNA Mutational Analysis
  • HLA Antigens / immunology
  • Hematopoietic Stem Cell Transplantation*
  • Histocompatibility
  • Humans
  • Immunoglobulins / blood
  • Killer Cells, Natural / immunology*
  • Male
  • Sequence Deletion / genetics*
  • Treatment Outcome


  • Adaptor Proteins, Signal Transducing
  • HLA Antigens
  • Immunoglobulins
  • LRBA protein, human