Clinical and Immunological Features, Genetic Variants, and Outcomes of Patients with CD40 Deficiency

J Clin Immunol. 2023 Dec 22;44(1):17. doi: 10.1007/s10875-023-01633-1.


Purpose: Inherited deficiencies of CD40 and CD40 ligand (CD40L) reflect the crucial immunological functions of CD40-CD40L interaction/signaling. Although numerous studies have provided a detailed description of CD40L deficiency, reports of CD40 deficiency are scarce. Herein, we describe the characteristics of all reported patients with CD40 deficiency.

Methods: The PubMed, Embase and Web of Science databases were searched for relevant literature published till 7th August 2023. Study deduplication and identification of relevant reports was performed using the online PICO Portal. The data were extracted using a pre-designed data extraction form and the SPSS software was used for analysis.

Results: Systematic literature review revealed 40 unique patients with CD40 deficiency. Respiratory tract and gastrointestinal infections were the predominant clinical manifestations (observed in 93% and 57% patients, respectively). Sclerosing cholangitis has been reported in nearly one-third of patients. Cryptosporidium sp. (29%) and Pneumocystis jirovecii (21%) were the most common microbes identified. Very low to undetectable IgG levels and severely reduced/absent switch memory B cells were observed in all patients tested/reported. Elevated IgM levels were observed in 69% patients. Overall, splice-site and missense variants were the most common (36% and 32%, respectively) molecular defects identified. All patients were managed with immunoglobulin replacement therapy and antimicrobial prophylaxis was utilized in a subset. Hematopoietic stem cell transplantation (HSCT) has been performed in 45% patients (curative outcome observed in 73% of these patients). Overall, a fatal outcome was reported in 21% patients.

Conclusions: We provide a comprehensive description of all important aspects of CD40 deficiency. HSCT is a promising curative treatment option for CD40 deficiency.

Keywords: CD40 antigen; CD40 deficiency; CD40 ligand; HIGM3; TNFRSF5; TNFSF5; hyper-IgM immunodeficiency syndrome.

Publication types

  • Systematic Review
  • Research Support, N.I.H., Intramural

MeSH terms

  • CD40 Antigens / genetics
  • CD40 Ligand / genetics
  • Cryptosporidiosis*
  • Cryptosporidium*
  • Humans
  • Hyper-IgM Immunodeficiency Syndrome* / genetics
  • Immunoglobulin M
  • Immunologic Deficiency Syndromes* / genetics
  • Lymphopenia*


  • CD40 Ligand
  • CD40 Antigens
  • Immunoglobulin M