The WASP P460S Mutation Causes a New Phenotype of WASP Mutations Related Disorder: X-Linked Pancytopenia

Mutations of the Wiskott-Aldrich Syndrome Protein (WASP) are responsible for a rare and severe disease: Wiskott-Aldrich Syndrome (WAS), including classic Wiskott-Aldrich Syndrome (WAS), X-linked thrombocytopenia (XLT), and congenital X-linked neutropenia (XLN). Classic WAS patients present typical WAS manifestation: eczema, thrombocytopenia, small platelet and recurrent infection, while XLT patients present thrombocytopenia, and XLN patients present congenital neutropenia. Bone marrow failure (BMF) is a series diseases characterized by pancytopenia in peripheral-blood(PB), different degree of bone marrow hypocellularity. In this study, we present two unrelated boys with pancytopenia who were admitted to our hospital on account of declining blood cells and different degree of hematopoietic failure. We identified a new WAS gene mutation C1378T inducing the WASP P460S mutation in both penitents by the second generation sequencing. Furthermore, one case developed T cell acute lymphoblastic leukemia (T-ALL) after severe pancytopenia recovered for 4 years and relapsed in mediastinum transplanted with cord blood for 1 year, another case recovered after haploidentical transplantation and kept stable for 1 year. To date, the role of WAS gene mutation in aplastic anemia-like hematopoietic failure remains unknown. We further verified WASP P460S mutation in these two patients by Sanger sequencing. In patient's PB cells, normal expression level of total WASP proteins was detected. This notion was different from general WASP deficiency classic WAS or XLT patients. To test the function of WASP P460S mutation in pancytopenia, we examined the effect of WASP P460S mutation on cell proliferation. Human myelogenous leukemia K562 cell line, which lacks endogenous WASP, was transfected with lentivirus vectors carrying mutant or wild type of WAS gene. We found that the cells expressing WASP P460S grew significantly slower than the cells expressing the wild type. Moreover, actin polymerization assay showed that increased actin polymerization function in WASP P460S mutation compared with wild type. In addition, P460S mutation had no obvious effect on Daunorubicin-induced apoptosis response. Our findings revealed that the WASP P460S mutation played a role in the inhibition of cell proliferation and actin polymerization which may lead to a new phenotype for WASP mutation related X-linked pancytopenia.