Scientific article
Case report
English

ASXL1 deficiency causes epigenetic dysfunction, combined immunodeficiency, and EBV-associated lymphoma

Published inThe journal of experimental medicine, vol. 222, no. 10, e20240945
Publication date2025-10-06
First online date2025-07-31
Abstract

Inborn errors of immunity (IEIs) are caused by deleterious variants in immune-related genes. ASXL1 is an epigenetic modifier not previously linked to an IEI. Clonal hematopoiesis and hematologic neoplasms often feature somatic ASXL1 variants, and Bohring-Opitz syndrome, a neurodevelopmental disorder, is caused by heterozygous truncating ASXL1 variants. We present an IEI caused by biallelic germline missense variants in ASXL1. The patient had a history of hematologic abnormalities and viral-associated complications, including chronic macrocytosis, persistent vaccine-strain rubella granulomas, and EBV-associated Hodgkin lymphoma. Immunophenotyping revealed loss of B cells, hypogammaglobulinemia, and impairments in cytotoxic T and NK cell populations. T cells exhibited skewing toward an exhausted memory phenotype, global DNA methylation loss, and increased epigenetic aging. These aberrations were ameliorated by wild-type ASXL1 transduction, confirming the patient variants' pathogenicity. This study defines a novel human IEI caused by ASXL1 deficiency, a diagnosis that should be considered in individuals with chronic viral infections, viral-associated malignancies, and combined immune deficiency.

Keywords
  • Humans
  • DNA Methylation / genetics
  • Epigenesis, Genetic
  • Epstein-Barr Virus Infections / genetics
  • Epstein-Barr Virus Infections / complications
  • Herpesvirus 4, Human
  • Immunologic Deficiency Syndromes / genetics
  • Lymphoma / genetics
  • Lymphoma / virology
  • Repressor Proteins / deficiency
  • Repressor Proteins / genetics
Funding
  • CIHR [EGM-141897]
  • CIHR [PJT-178054]
  • Genome British Columbia [SIP007]
  • Michael Smith Health Research BC [HPI-2018-2041]
Citation (ISO format)
FU, Maggie P et al. ASXL1 deficiency causes epigenetic dysfunction, combined immunodeficiency, and EBV-associated lymphoma. In: The journal of experimental medicine, 2025, vol. 222, n° 10, p. e20240945. doi: 10.1084/jem.20240945
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Article (Published version)
accessLevelRestricted
Identifiers
Journal ISSN0022-1007
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Creation20/08/2026 10:51:05
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