Griscelli syndrome (GS) type 2 is an autosomal recessive disorder represented by pigment dilution and impaired cytotoxic T lymphocyte (CTL) activity. NK activity has been scarcely investigated in GS patients. Here, we describe a new patient, possessing a hemophagocytic syndrome with a homozygous Q118X nonsense RAB27A mutation. Single specific primerpolymerase chain reaction (SSP-PCR) was developed based on this mutation and is currently used in prenatal genetic analysis. As expected, CTLs in the patient are not functional and NK cytotoxicity against K562 or 721.221 cells is diminished. Surprisingly, however, we demonstrate that CD16-mediated killing is intact in this patient and is therefore RAB27A independent, whereas NKp30-mediated killing is impaired and is therefore RAB27A dependent. We further analyzed the signaling pathways of these 2 receptors and demonstrated phosphorylation of Vav1 after CD16 activation but not after NKp30 engagement. Thus, we identify a novel homozygous mutation in the RAB27A gene of a new GS patient, observe for the first time that some activating NK receptors function in GS patients, and demonstrate a functional dichotomy in the killing mediated by these human NK-activating receptors. (
IntroductionNatural killer (NK) cells are the lymphocytes of innate immunity, able to identify and eliminate virus-infected and tumor cells without prior antigen stimulation. 1,2 In addition, secretion of cytokines by NK cells recruits and activates additional immune cells and modulates the adaptive immune response. 3,4 Unlike other lymphocytes, NK cells do not express any single rearranged receptor such as the T-or B-cell receptors, but rather use a limited number of activating receptors. 5,6 The major human NK-activating receptors are NKp30, NKp44, NKp46, NKG2D, and the Fc␥RIIIA receptor CD16. 2,7 Engagement of NK lysis receptors leads to cytoskeleton reorganization, translocation of lytic granules, and directed exocytosis to facilitate the final step of killing. The precise understanding of signal transduction pathways of these receptors is therefore crucial for our basic understanding of how NK cells function.Griscelli syndrome (GS) was first described by Claude Griscelli et al, 8 who described 2 patients with a distinctive silver-gray hair color and impaired immune activity. Since the first description, heterogeneity in clinical manifestations of the syndrome has been recognized in about 100 patients reported so far. Genetic studies found mutations in MYO5A, RAB27A, or MLPH, and patients were thereafter categorized as GS type 1, 2, or 3, respectively. 9-11 The abnormal pigmentation is a common feature of all of these patients and immunologic impairments are associated with RAB27A mutations, whereas MYO5A and MLPH have redundant role in lymphoid cells. 12 Despite the apparent immunodeficiency, the major clinical difficulty is not an overwhelming infection, but rather a fatal hemophagocytic syndrome caused by inappropriate and excessive lymphoid-cell activation and cytokine release often triggered...