IntroductionWiskott Aldrich syndrome (WAS) is a primary immunodeficiency characterized by a broad immune defect, thrombocytopenia, severe eczema, and an increased susceptibility to both autoimmunity and hematologic malignancy. 1 The disease is caused by mutations in the gene encoding the WAS protein (WASp), a key regulator of the actin cytoskeleton in hematopoietic cells. 2,3 Cytosolic WASp exists in an autoinhibited conformation promoted by constitutive binding of the EVH1 domain to WASp Interacting Protein (WIP). [4][5][6][7][8] Activation induces a conformational change exposing the VCA (Verprolin homology, Central region, Acidic domain) domain, which binds the Arp2/3 complex, 9,10 initiating actin filament nucleation and polymerization. 11 WASp activity is regulated through the combined influence of many binding partners and posttranslational modification, of which the Rho GTPase Cdc42 and tyrosine phosphorylation have particular importance. 1 Mutations resulting in complete loss of WASp expression are predictive of severe, classic WAS while missense mutations in the EVH1 domain generally result in residual low-level WASp expression and cause milder X-linked thrombocytopenia (XLT). [12][13][14][15] Despite this, there is significant clinical heterogeneity between different EVH1 missense mutations. In particular, mutations within exon 4 are associated with a more severe clinical phenotype. 14,15 A recently published multicenter analysis of the clinical outcomes of XLT patients revealed significantly increased rates of infections, autoimmunity, and malignancy resulting in a median severe-eventfree survival of only 10.2 years. 16 Therefore, further categorization and mechanistic understanding of mutations associated with more severe clinical features is important.The common mechanism of action for disease-causing EVH1 missense mutations appears to be enhanced protein degradation as a result of reduced WIP binding. Identification of the EVH1-binding surface for WIP as a long coiled surface clarified why so many different mutations could have the same effect. Based on this model, many EVH1 mutations have either been demonstrated Submitted January 13, 2012; accepted October 11, 2012. Prepublished online as Blood First Edition paper, November 15, 2012; DOI 10.1182 DOI 10. /blood-2012.The online version of this article contains a data supplement.The publication costs of this article were defrayed in part by page charge payment. Therefore, and solely to indicate this fact, this article is hereby marked ''advertisement'' in accordance with 18 USC section 1734.
Methods
MiceC57BL/6 (B6) wild-type (Charles River Laboratories) and WAS KO mice (supplied by T. Strom, Memphis, TN) were housed in specified pathogenfree conditions and used at 6-18 weeks of age. Experiments were performed under a Home Office-approved project license (held by S.B.). Immature murine BM derived dendritic cells (BMDCs) were generated by culturing in RPMI medium supplemented with 10% FCS, 100 units/mL of penicillin, and 100 g/mL of streptomycin in...