Diagnosing XLP1 in patients with hemophagocytic lymphohistiocytosis

Raffaella Meazza, Claudia Tuberosa, Valentina Cetica, Michela Falco, Silvia Parolini, Sam Grieve, Gillian M. Griffiths, Elena Sieni, Stefania Marcenaro, Concetta Micalizzi, Davide Montin, Franca Fagioli, Alessandro Moretta, Maria C. Mingari, Lorenzo Moretta, Luigi D. Notarangelo, Cristina Bottino, Maurizio Aricò, Daniela Pende

Research output: Contribution to journalArticlepeer-review


Background Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening, heterogeneous, hyperinflammmatory disorder. Prompt identification of inherited forms resulting from mutation in genes involved in cellular cytotoxicity can be crucial. X-linked lymphoproliferative disease 1 (XLP1), due to mutations in SH2D1A (Xq25) encoding signaling lymphocyte activation molecule-associated protein (SAP), may present with HLH. Defective SAP induces paradoxical inhibitory function of the 2B4 coreceptor and impaired natural killer (NK) (and T) cell response against EBV-infected cells. Objective To characterize a cohort of patients with HLH and XLP1 for SAP expression and 2B4 function in lymphocytes, proposing a rapid diagnostic screening to direct mutation analysis.

MethodsWe set up rapid assays for 2B4 function (degranulation or 51Cr-release) to be combined with intracellular SAP expression in peripheral blood NK cells. We studied 12 patients with confirmed mutation in SH2D1A and some family members.

Results The combined phenotypic/functional assays allowed efficient and complete diagnostic evaluation of all patients with XLP1, thus directing mutation analysis and treatment. Nine cases were SAP-, 2 expressed SAP with mean relative fluorescence intensity values below the range of healthy controls (SAPdull), and 1, carrying the R55L mutation, was SAP+. NK cells from all patients showed inhibitory 2B4 function and defective killing of B-EBV cells. Carriers with SH2D1A mutations abolishing SAP expression and low percentage of SAP+ cells showed neutral 2B4 function at the polyclonal NK cell level. Three novel SH2D1A mutations have been identified.

Conclusions Study of SAP expression is specific but may have insufficient sensitivity for screening XLP1 as a single tool. Combination with 2B4 functional assay allows identification of all cases.

Original languageEnglish
Pages (from-to)1381-1387.e7
JournalJournal of Allergy and Clinical Immunology
Issue number6
Publication statusPublished - Dec 1 2014


  • 2B4 function
  • HLH
  • NK cells
  • SAP expression
  • XLP1

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology


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