Abstract
Immunodeficiency with centromeric instability and facial anomalies (ICF) syndrome is a primary immunodeficiency, predominantly characterized by agammaglobulinemia or hypoimmunoglobulinemia, centromere instability and facial anomalies. Mutations in two genes have been discovered to cause ICF syndrome: DNMT3B and ZBTB24. To characterize the clinical features of this syndrome, as well as genotype–phenotype correlations, we compared clinical and genetic data of 44 ICF patients. Of them, 23 had mutations in DNMT3B (ICF1), 13 patients had mutations in ZBTB24 (ICF2), whereas for 8 patients, the gene defect has not yet been identified (ICFX). While at first sight these patients share the same immunological, morphological and epigenetic hallmarks of the disease, systematic evaluation of all reported informative cases shows that: (1) the humoral immunodeficiency is generally more pronounced in ICF1 patients, (2) B- and T-cell compartments are both involved in ICF1 and ICF2, (3) ICF2 patients have a significantly higher incidence of intellectual disability and (4) congenital malformations can be observed in some ICF1 and ICF2 cases. It is expected that these observations on prevalence and clinical presentation will facilitate mutation-screening strategies and help in diagnostic counseling.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Hagleitner MM, Lankester A, Maraschio P et al: Clinical spectrum of immunodeficiency, centromeric instability and facial dysmorphism (ICF syndrome). J Med Genet 2008; 45: 93–99.
Blanco-Betancourt CE, Moncla A, Milili M et al: Defective B-cell-negative selection and terminal differentiation in the ICF syndrome. Blood 2004; 103: 2683–2690.
Pezzolo A, Prigione I, Facchetti P et al: T-cell apoptosis in ICF syndrome. J Allergy Clin Immunol 2001; 108: 310–312.
Pezzolo A, Prigione I, Chiesa S et al: A novel case of immunodeficiency, centromeric instability, and facial anomalies (the ICF syndrome): immunologic and cytogenetic studies. Haematologica 2002; 87: 329–331.
Hansen RS, Wijmenga C, Luo P et al: The DNMT3B DNA methyltransferase gene is mutated in the ICF immunodeficiency syndrome. Proc Natl Acad Sci USA 1999; 96: 1–6.
Xu GL, Bestor TH, Bourc’his D et al: Chromosome instability and immunodeficiency syndrome caused by mutations in a DNA methyltransferase gene. Nature 1999; 402: 1–5.
de Greef JC, Wang J, Balog J et al: Mutations in ZBTB24 are associated with immunodeficiency, centromeric instability, and facial anomalies syndrome type 2. Am J Hum Genet 2011; 88: 796–804.
Chouery E, Abou-Ghoch J, Corbani S et al: A novel deletion in ZBTB24 in a Lebanese family with immunodeficiency, centromeric instability, and facial anomalies syndrome type 2. Clin Genet 2012; 82: 1–5.
Jiang YL, Rigolet M, Bourc’his D et al: DNMT3B mutations and DNA methylation defect define two types of ICF syndrome. Hum Mutat 2005; 25: 56–63.
Kanariou M, Petridou E, Liatsis M et al: Age patterns of immunoglobulins G, A & M in healthy children and the influence of breast feeding and vaccination status. Pediatr Allergy Immunol 1995; 6: 24–29.
Comans-Bitter WM, de Groot R, van den Beemd R et al: Immunophenotyping of blood lymphocytes in childhood. Reference values for lymphocyte subpopulations. J Pediatr 1997; 130: 388–393.
Kloeckener-Gruissem B, Betts DR, Zankl A, Berger W, Güngör T : A new and a reclassified ICF patient without mutations in DNMT3B and its interacting proteins SUMO-1 and UBC9. Am J Med Genet 2005; 136: 31–37.
Cerbone M, Wang J, Van der Maarel SM et al: Immunodeficiency, centromeric instability, facial anomalies ICF) syndrome, due to ZBTB24 mutations, presenting with large cerebral cyst. Am J Med Genet 2012; 158A: 1–4.
van den Brand M, Flucke UE, Bult P, Weemaes CM, van Deuren M : Angiosarcoma in a patient with immunodeficiency, centromeric region instability, facial anomalies (ICF) syndrome. Am J Med Genet 2011; 155A: 622–625.
Hultén M : Selective somatic pairing and fragility at 1q12 in a boy with common variable immunodeficiency: a new syndrome. Clin Genet 1978; 14: 294–295.
Gennery AR, Slatter MA, Bredius RG et al: Hematopoietic stem cell transplantation corrects the immunologic abnormalities associated with immunodeficiency-centromeric instability-facial dysmorphism syndrome. Pediatrics 2007; 120: e1341–e1344.
Sekigawa I, Kawasaki M, Ogasawara H et al: DNA methylation: its contribution to systemic lupus erythematosus. Clin Exp Med 2006; 6: 99–106.
Zhu X, Liang J, Li F et al: Analysis of associations between the patterns of global DNA hypomethylation and expression of DNA methyltransferase in patients with systemic lupus erythematosus. Int J Dermatol 2011; 50: 697–704.
Tadokoro Y, Ema H, Okano M, Li E, Nakauchi H : De novo DNA methyltransferase is essential for self-renewal, but not for differentiation, in hematopoietic stem cells. J Exp Med 2007; 204: 715–722.
Jia D, Jurkowska RZ, Zhang X, Jeltsch A, Cheng X : Structure of Dnmt3a bound to Dnmt3L suggests a model for de novo DNA methylation. Nature 2007; 449: 248–251.
Ueda Y, Okano M, Williams C et al: Roles for Dnmt3b in mammalian development: a mouse model for the ICF syndrome. Development 2006; 133: 1183–1192.
Feng J, Chang H, Li E, Fan G : Dynamic expression of de novo DNA methyltransferases Dnmt3a and Dnmt3b in the central nervous system. J Neurosci Res 2005; 79: 734–746.
Tiepolo L, Maraschio P, Gimelli G et al: Multibranched chromosomes 1, 9, and 16 in a patient with combined IgA and IgE deficiency. Hum Genet 1979; 51: 1–11.
Carpenter NJ, Filipovich A, Blaese RM, Carey TL, Berkel AI : Variable immunodeficiency with abnormal condensation of the heterochromatin of chromosomes 1, 9, and 16. J Pediatr 1988; 112: 1–8.
Turleau C, Cabanis M, Girault D et al: Multibranched chromosomes in the ICF syndrome: immunodeficiency, centromeric instability, and facial anomalies. Am J Med Genet 1989; 32: 1–5.
Smeets DF, Moog U, Weemaes CMR et al: ICF syndrome: a new case and review of the literature. Hum Genet 1994; 94: 1–7.
Schuffenhauer S, Bartsch O, Stumm M et al: DNA, FISH and complementation studies in ICF syndrome: DNA hypomethylation of repetitive and single copy loci and evidence for a trans acting factor. Hum Genet 1995; 96: 562–571.
Shirohzu H, Kubota T, Kumazawa A et al: Three novel DNMT3B mutations in Japanese patients with ICF syndrome. Am J Med Genet 2002; 112: 31–37.
Björck EJ, Bui TH, Wijmenga C, Grandell U, Nordenskjöld M : Early prenatal diagnosis of the ICF syndrome. Prenat Diagn 2000; 20: 828–831.
Rigolet M, Grégoire A, Lefort G et al: Early prenatal diagnosis of ICF syndrome by mutation detection. Prenat Diagn 2007; 27: 1075–1078.
Kaya N, Al-Muhsen S, Al-Saud B et al: ICF syndrome in Saudi Arabia: immunological, cytogenetic and molecular analysis. J Clin Immunol 2011; 31: 245–252.
Brown DC, Grace E, Sumner AT, Edmunds AT, Ellis PM : ICF syndrome immunodeficiency, centromeric instability and facial anomalies): investigation of heterochromatin abnormalities and review of clinical outcome. Hum Genet 1995; 96: 1–6.
Schuetz C, Barbi G, Barth TF et al: ICF syndrome: high variability of the chromosomal phenotype and association with classical Hodgkin lymphoma. Am J Med Genet 2007; 143A: 2052–2057.
Gimelli G, Varone P, Pezzolo A, Lerone M, Pistoia V : ICF syndrome with variable expression in sibs. J Med Genet 1993; 30: 1–5.
Acknowledgements
We thank all ICF families for their participation in this study. This study was supported by the National Institute of Allergy and Infectious Diseases (NIAID: AI090135).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Additional information
Supplementary Information accompanies this paper on European Journal of Human Genetics website
Rights and permissions
About this article
Cite this article
Weemaes, C., van Tol, M., Wang, J. et al. Heterogeneous clinical presentation in ICF syndrome: correlation with underlying gene defects. Eur J Hum Genet 21, 1219–1225 (2013). https://doi.org/10.1038/ejhg.2013.40
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/ejhg.2013.40
Keywords
This article is cited by
-
Enhanced CD19 activity in B cells contributes to immunodeficiency in mice deficient in the ICF syndrome gene Zbtb24
Cellular & Molecular Immunology (2023)
-
Immunophenotype, Karyotype and Molecular Findings in a Case of ICF Syndrome
Indian Journal of Hematology and Blood Transfusion (2023)
-
T Cell Repertoire Abnormality in Immunodeficiency Patients with DNA Repair and Methylation Defects
Journal of Clinical Immunology (2022)
-
Germline Abnormalities in DNA Methylation and Histone Modification and Associated Cancer Risk
Current Hematologic Malignancy Reports (2022)
-
Immune Reconstitution after Hematopoietic Stem Cell Transplantation in Immunodeficiency–Centromeric Instability–Facial Anomalies Syndrome Type 1
Journal of Clinical Immunology (2021)