A Novel Homozygous TTC7A Missense Mutation Results In Familial Multiple Intestinal Atresia And Combined Immunodeficiency

Abstract Multiple intestinal atresia with combined immune deficiency (MIA-CID) are autosomal recessive disorders characterized by intestinal obstructions and profound immune defects. The study of patients with MIA and related disorders has established that tetratricopeptide repeat domain 7A (TTC7A) plays a critical role in intestinal and immune homeostasis and it is now shown that biallelic missense mutations have better survival outcomes. However, clues to related underlying molecular dysfunction remains elusive. In this study, we reported a patient with the diagnosis of severe CID and MIA that involved the pyloric diaphragm, ileum atresia, and colon stenosis, and the clinical course was complicated by multiple episodes of sepsis. In spite of multiple surgeries and supportive treatment, the patient died of severe sepsis and multiple organ failure at 3 months of age. The whole exome sequencing (WES) identified a novel homozygous TTC7A missense mutation (c.206T>C, p. L69P). The structural analysis showed that a hydrogen bond present between Gly65 and Leu69 in the wild-type TTC7A was broken by the Leu69Pro mutation. Moreover, this homozygous missense mutation led to a severely reduced TTC7A expression in lymphocytes and intestinal tissues, accompanied by prohibited lymphocyte development. Further studies demonstrated that the PI4K-FAM126A-EFR3A pathway was impaired in intestinal tissues. Our results strongly suggest that the missense mutation in TTC7A gene causes severe MIA-CID. More knowledge of the TTC7A protein functions will have important therapeutic implications for patients with MIA-CID.