Whole Exome Sequencing of T-B+ Severe Combined Immunodeficiency Egyptian infants, JAK3 predominance and novel variants.

Background Severe combined immunodeficiency (SCID) is fatal if not treated with immune reconstitution. In Egypt, T-B+ SCID accounts for 38.5% of SCID diagnoses. An accurate genetic diagnosis is essential for choosing appropriate treatment modalities and for offering genetic counseling to the patient's family. Objectives To describe the clinical, immunological and molecular characteristics of a cohort of twenty Egyptian patients with T-B+ SCID. Methods The initial diagnosis (based on clinical features and flow cytometry) was followed by molecular investigation (whole-exome sequencing). Results All patients had the classic clinical picture for SCID, including failure to thrive (n=20), oral candidiasis (n=17), persistent diarrhea (n=14), pneumonia (n=13), napkin dermatitis (n=10), skin rash (n=7), otitis media (n=3), and meningitis (n=2). Onset of manifestations was at the age of 2.4 ± 1.6 months and diagnosis at the age of 6.7±3.5 months, giving a diagnostic delay of 4.3 months. JAK3 gene variants were most frequent (n=12) with 3 novel variants identified, followed by IL2Rγ variants (n=6) with two novel variants. IL7Rα and CD3e variants were found once with a novel variant each. Conclusion T-B+NK- SCID accounted for around 90% of the Egyptian patients with T-B+SCID. Of these T-B+NK- SCID cases, 60% were autosomal recessive syndromes caused by JAK3 mutations and 30% were X-linked syndromes. It might be useful to sequence the JAK3 gene (i.e. targeted Sanger sequencing) in all T-B+ SCID patients, especially after X-linked SCID has been ruled out. Hence, no more than 10% of T-B+ SCID patients might require next-generation for a molecular diagnosis.