NOVEL SPLICING, MISSENSE, AND DELETION MUTATIONS IN 7 ADENOSINE-DEAMINASE DEFICIENT PATIENTS WITH LATE DELAYED-ONSET OF COMBINED IMMUNODEFICIENCY DISEASE - CONTRIBUTION OF GENOTYPE TO PHENOTYPE

We examined the genetic basis for adenosine deaminase (ADA) deficiency in seven patients with late / delayed onset of immunodeficiency, an u nderdiagnosed and relatively unstudied condition. Deoxyadenosine-media ted metabolic abnormalities were less severe than in the usual, early- onset disorder. Six patients were compound heterozygotes; 7 of 10 muta tions found were novel, including one deletion (DELTA1019-1020), three missense (Arg156 > His, Arg101 > Leu, Val177 > Met), and three splici ng defects (IVS 5, 5'ss T+6 > A; IVS 10, 5'ss G+1 > A; IVS 10, 3'ss G- 34 > A). Four of the mutations generated stop signals at codons 131, 3 21, 334, and 348; transcripts of all but the last, due to DELTA1019-10 20, were severely reduced. DELTA1019-1020 (like DELTA955-959, found in one patient and apparently recurrent) is at a short deletional hot sp ot. Arg156 > His, the product of which had detectable activity, was fo und in three patients whose second alleles were unlikely to yield acti ve ADA. The oldest patient diagnosed was homozygous for a single base change in intron 10, which activates a cryptic splice acceptor, result ing in a protein with 100 extra amino acids. We speculate that this '' macro ADA,'' as well as the Arg156 > His, Arg101 > Leu, Ser291 > Leu, and DELTA1019-1020 products, may contribute to mild phenotype. Tissue- specific variation in splicing efficiency may also ameliorate disease severity in patients with splicing mutations.