孤舟蓑笠翁
(2025-06-24 21:28):
#paper 【doi】10.1016/j.cell.2025.05.037;【发表年份】2025年;【期刊】Cell;【标题】Scalable generation and functional classification of genetic variants in inborn errors of immunity to accelerate clinical diagnosis and treatment。【内容总结】本研究旨在解决遗传性免疫缺陷病(如APDS综合征)中大量基因变体功能不明导致的诊断瓶颈问题,通过创新性地使用CRISPR碱基编辑技术(核心工具为NG-ABE8e和NG-ABE9)在人类原代T细胞中高通量构建并测试了PIK3CD/PIK3R1基因的数千个变体,结合磷酸化流式细胞术检测关键信号分子pAKT/pS6的动态变化,成功将100+个临床意义未明变体(VUS)精准分类为功能增益型(GOF)或功能缺失型(LOF),并首次发现PIK3R1基因iSH2结构域变体会导致药物leniolisib部分耐药(可通过联合mTOR抑制剂逆转),同时整合人群基因组数据揭示APDS真实患病率可能高达1/5,000(远超原有认知),为加速精准诊断和靶向治疗提供了新范式。
Scalable generation and functional classification of genetic variants in inborn errors of immunity to accelerate clinical diagnosis and treatment
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Abstract:
Next-generation sequencing is pivotal for diagnosing inborn errors of immunity (IEI) but predominantly yields variants of uncertain significance (VUS), creating clinical ambiguity. Activated PI3Kδ syndrome (APDS) is caused by gain-of-function (GOF) variants in PIK3CD or PIK3R1, which encode the PI3Kδ heterodimer. We performed massively parallel base editing of PIK3CD/PIK3R1 in human T cells and mapped thousands of variants to a clinically important readout (phospho-AKT/S6), nominating >100 VUS and unannotated variants for functional classification and validating 27 hits. Leniolisib, an FDA-approved PI3Kδ inhibitor, rescued aberrant signaling and dysfunction in GOF-harboring T cells and revealed partially drug-resistant PIK3R1 hotspots that responded to novel combination therapies of leniolisib with mTORC1/2 inhibition. We confirmed these findings in T cells from APDS patients spanning the functional spectrum discovered in the screen. Integrating our screens with population-level genomic studies revealed that APDS may be more prevalent than previously estimated. This work exemplifies a broadly applicable framework for removing ambiguity from sequencing in IEI.
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