Intermediate phenotypes in patients with autosomal dominant hyper-IgE syndrome caused by somatic mosaicism Amy P. Hsu, BA, Kathryn J. Sowerwine, MD,

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Intermediate phenotypes in patients with autosomal dominant hyper-IgE syndrome caused by somatic mosaicism Amy P. Hsu, BA, Kathryn J. Sowerwine, MD, Monica G. Lawrence, MD, Joie Davis, APRN, APNG, Carolyn J. Henderson, BA, Kol A. Zarember, PhD, Mary Garofalo, RN, BSN, John I. Gallin, MD, Douglas B. Kuhns, PhD, Theo Heller, MD, Joshua D. Milner, MD, Jennifer M. Puck, MD, Alexandra F. Freeman, MD, Steven M. Holland, MD Journal of Allergy and Clinical Immunology Volume 131, Issue 6, Pages 1586-1593 (June 2013) DOI: 10.1016/j.jaci.2013.02.038 Copyright © 2013 Terms and Conditions

Fig 1 A, Pedigree of family J017. B, Pedigree of family J149. Open symbols represent unaffected subjects, whereas solid symbols indicate STAT3 mutation, and striped symbols reflect the mosaic subjects. Small circles represent miscarriages. The diamond-shaped symbol indicates sex is unknown, and the number in the shape indicates the number of offspring. Journal of Allergy and Clinical Immunology 2013 131, 1586-1593DOI: (10.1016/j.jaci.2013.02.038) Copyright © 2013 Terms and Conditions

Fig 2 Members of family J017: subject J017.3 along with his 2 affected children, subjects J017.1 and J07.10. The classic AD-HIES facial features (broad nose, prominent brow, and facial asymmetry) are present in the children but absent in the father. Journal of Allergy and Clinical Immunology 2013 131, 1586-1593DOI: (10.1016/j.jaci.2013.02.038) Copyright © 2013 Terms and Conditions

Fig 3 Family J017: STAT3 sequence for a control subject, subject J017.10, and subject J017.3. A, cDNA sequencing (c.1145 G>A). The control shows only the G allele in the boxed region. Subject J017.10 demonstrates 2 alleles with WT and mutant bases at similar heights, roughly half the height of the control subject. Subject J017.3 has decreased WT 1145G compared with control values and a small 1145G>A peak seen near the baseline. The arrow points to the mutant green A peak. B, Genomic DNA sequencing. The common C/G SNP found within intron 13 shows 2 separate and equally abundant alleles in subject J017.3, whereas only the G allele is seen in the control subject. Journal of Allergy and Clinical Immunology 2013 131, 1586-1593DOI: (10.1016/j.jaci.2013.02.038) Copyright © 2013 Terms and Conditions

Fig 4 Family J149: STAT3 cDNA sequencing. The c.1309C>T sequence for the healthy son and subjects J149.1, J149.2, J149.3, and J149.4 is shown. The STAT3 c.1309C>T mutation is absent in the healthy son (homozygous C) but easily appreciated in the heterozygous affected sons J149.1, J149.2, and J149.3 (heterozygous C and T). Subject J149.4 has a diminished WT 1309C allele compared with the control subject and a small 1309T peak near the baseline. The arrow is pointing to the mutant red T peak. Journal of Allergy and Clinical Immunology 2013 131, 1586-1593DOI: (10.1016/j.jaci.2013.02.038) Copyright © 2013 Terms and Conditions

Fig 5 Family J017. Genomic DNA sequences for subject J017.3 in T cells, natural killer cells, monocytes, B cells, eosinophils, and neutrophils all have a mosaic pattern at c.1145G>A and are heterozygous for the SNP at c.1233+44C>G. Journal of Allergy and Clinical Immunology 2013 131, 1586-1593DOI: (10.1016/j.jaci.2013.02.038) Copyright © 2013 Terms and Conditions

Fig 6 A, Genomic DNA from various somatic tissues were amplified and sequenced from J017.4 exons 12 to 14 of STAT3. Fibroblasts demonstrated only the WT peak. DNA from the stomach biopsy specimen showed heterozygosity for the mutation. B, Oral, circulating, and migrating blister neutrophils contain mutant peaks at similar heights. The chromatograms suggest that the percentage of mosaicism is similar in sorted circulating neutrophils and migrating blister neutrophils. The mouthwash sample (neutrophils) also demonstrates a mosaic pattern. Journal of Allergy and Clinical Immunology 2013 131, 1586-1593DOI: (10.1016/j.jaci.2013.02.038) Copyright © 2013 Terms and Conditions

Fig 7 TaqMan real-time PCR demonstrating the percentage of mutant cells for isolated lineages of subject J149.4. Calculating the percentage of cells with the mutant allele yielded 52% mosaicism in whole blood, 51% in T cells, 63% in B cells, 53% in natural killer (NK) cells, 55% in monocytes, 50% in granulocytes, and 60% in buccal DNA. Journal of Allergy and Clinical Immunology 2013 131, 1586-1593DOI: (10.1016/j.jaci.2013.02.038) Copyright © 2013 Terms and Conditions

Fig 8 A, IL-17– and IL-22–producing cells from patients and control subjects. CD3+CD4+IL-17+ and CD3+CD4+IL-22+ cell percentages for control subjects and subjects J017.3, J149.3, J149.2, and J149.4 after stimulation with phorbol 12-myristate 13-acetate/ionomycin. The 2 mosaic subjects (subjects J017.3 and J149.4) have IL-17+ and IL-22+ cell numbers in the normal range, whereas cell numbers in the heterozygous children (subjects J149.3 and J149.2) are greatly diminished. B, Mean fluorescence intensity (MFI) in the control subject and the 2 mosaic subjects (subjects J017.3 and J149.4). Journal of Allergy and Clinical Immunology 2013 131, 1586-1593DOI: (10.1016/j.jaci.2013.02.038) Copyright © 2013 Terms and Conditions