Evidence map›Paper›PMID 39854693›Full record

ArticleBlood2025

One hundred thirty-four germ line PU.1 variants and the agammaglobulinemic patients carrying them.

Ainsley V C Knox, Lauren Y Cominsky, Di Sun, Emylette Cruz Cabrera, Brian E Nolan, Edann Ofray, Elisa Benetti, Camilla Visconti, Federica Barzaghi, Sergio D Rosenzweig and 43 more

Abstract read
In one paragraph

Article in Blood, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed.

  1. Review
  2. Article
  3. Review
  4. Review
  5. Article
  6. Revisiting X-linked agammaglobulinemia.Journal of human immunity · 2025
    Review
  7. Case Report: A novelFrontiers in immunology · 2025
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

53 authors.

Ainsley V C KnoxDivision of Immunology and Allergy, Children's Hospital of Philadelphia, Philadelphia, PA.
Lauren Y CominskyDivision of Immunology and Allergy, Children's Hospital of Philadelphia, Philadelphia, PA.ORCID 0009-0002-0501-1617
Di SunDivision of Immunology and Allergy, Children's Hospital of Philadelphia, Philadelphia, PA.ORCID 0000-0001-5786-2152
Emylette Cruz CabreraDivision of Immunology and Allergy, Children's Hospital of Philadelphia, Philadelphia, PA.
Brian E NolanDivision of Rheumatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
Edann OfrayDivision of Immunology and Allergy, Children's Hospital of Philadelphia, Philadelphia, PA.
Elisa BenettiCenter for Omics Sciences, IRCCS San Raffaele Scientific Institute, Milan, Italy.ORCID 0000-0002-0819-604X
Camilla ViscontiVita-Salute San Raffaele University, Milan, Italy.
Federica BarzaghiSan Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy.ORCID 0000-0003-4498-1712
Sergio D RosenzweigImmunology Service, Department of Laboratory Medicine, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD.ORCID 0000-0002-5550-9678
Monica G LawrenceDivision of Asthma, Allergy and Immunology, Department of Medicine, University of Virginia, Charlottesville, VA.
Kathleen E SullivanDivision of Immunology and Allergy, Children's Hospital of Philadelphia, Philadelphia, PA.
Samuel YoonDivision of Immunology and Allergy, Children's Hospital of Philadelphia, Philadelphia, PA.
Suzanna RachimiDivision of Immunology and Allergy, Children's Hospital of Philadelphia, Philadelphia, PA.ORCID 0000-0001-7294-8683
Nurcicek PademDivision of Pediatric Pulmonology, Allergy-Immunology, and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.ORCID 0000-0001-9558-0746
Erin ConboyDepartment of Medical and Molecular Genetics, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.
Maja StojanovicClinic of Allergy and Immunology, University Clinical Center of Serbia, Belgrade, Serbia.ORCID 0000-0003-4589-7344
Gordana PetrovicDepartment of Immunology, Mother and Child Health Care Institute of Serbia, Belgrade, Serbia.
Srdjan PasicDepartment of Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.ORCID 0000-0001-7761-0024
Joseph ChurchDivision of Clinical Immunology and Allergy, Children's Hospital Los Angeles, Los Angeles, CA.
Ronald M FerdmanDivision of Clinical Immunology and Allergy, Children's Hospital Los Angeles, Los Angeles, CA.ORCID 0000-0001-5744-0427
Fabio CandottiDivision of Immunology and Allergy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.ORCID 0000-0001-6399-6042
Tiphaine ArlabosseDepartment of Woman, Mother, Child, Unit of Pediatric Immunology, Allergology and Rheumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.ORCID 0000-0002-2029-0733
Katerina TheodoropoulouDepartment of Woman, Mother, Child, Unit of Pediatric Immunology, Allergology and Rheumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Cullen M DutmerDepartment of Pediatrics, Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO.ORCID 0000-0001-9806-4739
László MaródiDepartment of Dermatology, Primary Immunodeficiency Clinical Unit and Laboratory, Semmelweis University, Budapest, Hungary.
Gabriella SzücsDepartment of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
Arnon BroidesPediatric Immunology Clinic, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Amit NahumPediatric Immunology Clinic, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.ORCID 0000-0002-1980-1639
Jacov LevyPediatric Immunology Clinic, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Kaisa KettunenLaboratory of Genetics, HUS Diagnostic Center, University of Helsinki, Helsinki, Finland.
Ravindra DaddaliTranslational Immunology Research Program, University of Helsinki, Helsinki, Finland.ORCID 0000-0001-5890-0376
Mikko SeppänenTranslational Immunology Research Program, University of Helsinki, Helsinki, Finland.ORCID 0000-0001-7547-0902
Markku VänttinenDepartment of Medicine, Unit of Infectious Diseases and Hospital Hygiene, Kuopio University Hospital, Kuopio, Finland.
Timi MarteliusInflammation Center, Department of Infectious Disease, HUS Helsinki University Hospital and University of Helsinki, Helsinki, Finland.ORCID 0000-0002-3678-958X
Juha GrönholmTranslational Immunology Research Program, University of Helsinki, Helsinki, Finland.ORCID 0000-0002-4190-0000
Matilde PeriDepartment of Health Sciences, University of Florence, Florence, Italy.
Chiara AzzariDepartment of Health Sciences, University of Florence, Florence, Italy.ORCID 0000-0001-7236-1655
Silvia RicciDepartment of Health Sciences, University of Florence, Florence, Italy.ORCID 0000-0001-7140-1694
Samar OjaimiDepartment of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia.
Emily S J EdwardsDepartment of Immunology, School of Translational Medicine, Monash University, Melbourne, VIC, Australia.ORCID 0000-0002-0240-4370
Menno C van ZelmDepartment of Immunology, School of Translational Medicine, Monash University, Melbourne, VIC, Australia.
Jinqiao SunDepartment of Clinical Immunology, Children's Hospital of Fudan University, National Children Medical Center, Shanghai, China.
Hassan AbolhassaniDivision of Immunology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden.ORCID 0000-0002-4838-0407
Qiang Pan-HammarströmDivision of Immunology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden.ORCID 0000-0003-1990-8804
Hakon HakonarsonDepartment of Pediatrics, Perelman School of Medicine, Philadelphia, PA.
Daniel MayrSaint Anna Children's Cancer Research Institute, Vienna, Austria.
Kaan BoztugDepartment of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
Bertrand BoissonSt. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY.ORCID 0000-0001-5240-3555
Jean-Laurent CasanovaSt. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY.ORCID 0000-0002-7782-4169
Carole Le CozInfinity, Toulouse Institute for Infectious and Inflammatory Diseases, University of Toulouse, National Centre for Scientific Research, INSERM, Toulouse, France.
Gregory M K PoonDepartment of Chemistry and Center for Diagnostics and Therapeutics, Georgia State University, Atlanta, GA.ORCID 0000-0001-5107-9458
Neil RombergDivision of Immunology and Allergy, Children's Hospital of Philadelphia, Philadelphia, PA.ORCID 0000-0002-1881-5318

Funding

Developing, Demonstrating, and Disseminating Innovative Programs to Achieve Translational SuccessUL1TR001866 · NCATS · ROCKEFELLER UNIVERSITY · PI COLLER, BARRY, KRUEGER, JAMES G · 2016 to 2025
$40.6M
Regulation of IgA class switching in the intestinal mucosaP01AI061093 · NIAID · MOUNT SINAI SCHOOL OF MEDICINE OF NYU · PI CASANOVA, JEAN-LAURENT · 2004 to 2021
$29.8M
Promoter interactome-aided mapping of unexplored CVID genetic landscapesR01AI146026 · NIAID · CHILDREN'S HOSP OF PHILADELPHIA · PI ROMBERG, NEIL DAVID · 2019 to 2023
$2.9M
The molecular circuits controlling human T follicular regulatory cell developmentR01AI179680 · NIAID · CHILDREN'S HOSP OF PHILADELPHIA · PI NEIL DAVID ROMBERG · 2025 to 2026
$1.6M
Genetic determinates of SPI1 expression and activity in human germinal center B cellsR01AI184976 · NIAID · CHILDREN'S HOSP OF PHILADELPHIA · PI NEIL DAVID ROMBERG · 2025 to 2026
$1.6M
Direct chemical control of the hematopoietic master transcription factor PU.1R01HL155178 · NHLBI · GEORGIA STATE UNIVERSITY · PI POON, GREGORY MAN KAI · 2021 to 2023
$1.2M
NCATS NIH HHS UL1 TR001866NHLBI NIH HHS R01 HL155178NIAID NIH HHS P01 AI061093NIAID NIH HHS R01 AI146026NIAID NIH HHS R01 AI179680NIAID NIH HHS R01 AI184976
6 · The paper itself

Abstract

abstractLeukopoiesis is lethally arrested in mice lacking the master transcriptional regulator PU.1. Depending on the animal model, subtotal PU.1 loss either induces acute myeloid leukemia or arrests early B-cell and dendritic-cell development. Although humans with absolute PU.1 deficiency have not been reported, a small cadre of congenital agammaglobulinemia patients with sporadic, inborn PU.1 haploinsufficiency was recently described. To better estimate the penetrance, clinical complications, immunophenotypic features, and malignancy risks of PU.1-mutated agammaglobulinemia (PU.MA), a collection of 134 novel or rare PU.1 variants from publicly available databases, institutional cohorts, previously published reports, and unsolved agammaglobulinemia cases were functionally analyzed. In total, 25 loss-of-function (LOF) variants were identified in 33 heterozygous carriers from 21 kindreds across 13 nations. Of individuals harboring LOF PU.1 variants, 22 were agammaglobulinemic, 5 displayed antibody deficiencies, and 6 were unaffected, indicating an estimated disease penetrance of 81.8% with variable expressivity. In a cluster of patients, disease onset was delayed, sometimes into adulthood. All LOF variants conveyed effects via haploinsufficiency, either by destabilizing PU.1, impeding nuclear localization, or directly interfering with transcription. PU.MA patient immunophenotypes consistently demonstrated B-cell, conventional dendritic-cell, and plasmacytoid dendritic-cell deficiencies. Associated infectious and noninfectious symptoms hewed closely to X-linked agammaglobulinemia and not monogenic dendritic-cell deficiencies. No carriers of LOF PU.1 variants experienced hematologic malignancies. Collectively, in vitro and clinical data indicate heterozygous LOF PU.1 variants undermine humoral immunity but do not convey strong leukemic risks.

Indexed as

AgammaglobulinemiaGerm-Line MutationLoss of Function MutationProto-Oncogene ProteinsTrans-ActivatorsAdolescentAdultChildChild, PreschoolFemaleHumansInfantMaleMiddle AgedPenetranceProto-Oncogene Protein Spi-1Proto-Oncogene ProteinsProto-Oncogene Protein Spi-1Trans-Activators

Identifiers

PMID39854693
PMCPMC12163740

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.