Loss of NHEJ1 Protein Due to a Novel Splice Site Mutation in a Family Presenting with Combined Immunodeficiency, Microcephaly, and Growth Retardation and Literature Review

J Clin Immunol. 2017 Aug;37(6):575-581. doi: 10.1007/s10875-017-0423-5. Epub 2017 Jul 24.


Introduction: Non-homologous end joining gene 1 (NHEJ1) defect is a rare form of primary immune deficiency. Very few cases have been described from around the world.

Purpose: We are reporting the first family from the Arabian Gulf with three siblings presenting with combined immunodeficiency (CID), microcephaly, and growth retardation due to a novel NHEJ1 splice site mutation, in addition to a review of the previously published literature on this subject.

Methods: Patients' clinical, immunological, and laboratory features were examined. Samples were subjected to targeted next-generation sequencing (NGS). The pathogenic change in NHEJ1 was confirmed by Sanger sequencing, then further assessed at the RNA and protein levels.

Results: Patients were found to have a homozygous splice site mutation immediately downstream of exon 3 in NHEJ1 (c.390 + 1G > C). This led to two distinct mRNA products, one of which demonstrated skipping of the last 69 basepairs (bp) of exon 3 while the other showed complete skipping of the entire exon. Although both deletions were in-frame, immunoblotting did not reveal any NHEJ1 protein products in patient cells, indicating a null phenotype.

Conclusion: Patients presenting with CID, microcephaly, and growth retardation should be screened for NHEJ1 gene mutations. We discuss our data in the context of one of our patients who is still alive at the age of 30 years, without transplantation, and who is the longest known survivor of this disease.

Keywords: Cernunnos-XLF deficiency; NHEJ1 mutation; growth retardation; microcephaly; primary immune deficiency.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adult
  • Alternative Splicing
  • Child
  • DNA Repair Enzymes / genetics*
  • DNA-Binding Proteins / genetics*
  • Developmental Disabilities / genetics*
  • Family
  • Female
  • High-Throughput Nucleotide Sequencing
  • Homozygote
  • Humans
  • Immunologic Deficiency Syndromes / genetics*
  • Male
  • Microcephaly / genetics*
  • Mutation / genetics*
  • Pedigree
  • Phenotype
  • Protein Isoforms / genetics*
  • RNA Splice Sites / genetics*
  • Siblings


  • DNA-Binding Proteins
  • NHEJ1 protein, human
  • Protein Isoforms
  • RNA Splice Sites
  • DNA Repair Enzymes