AUTHOR=Fliegauf Manfred , Kinnunen Matias , Posadas-Cantera Sara , Camacho-Ordonez Nadezhda , Abolhassani Hassan , Alsina Laia , Atschekzei Faranaz , Bogaert Delfien J. , Burns Siobhan O. , Church Joseph A. , Dückers Gregor , Freeman Alexandra F. , Hammarström Lennart , Hanitsch Leif Gunnar , Kerre Tessa , Kobbe Robin , Sharapova Svetlana O. , Siepermann Kathrin , Speckmann Carsten , Steiner Sophie , Verma Nisha , Walter Jolan E. , Westermann-Clark Emma , Goldacker Sigune , Warnatz Klaus , Varjosalo Markku , Grimbacher Bodo TITLE=Detrimental NFKB1 missense variants affecting the Rel-homology domain of p105/p50 JOURNAL=Frontiers in Immunology VOLUME=13 YEAR=2022 URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2022.965326 DOI=10.3389/fimmu.2022.965326 ISSN=1664-3224 ABSTRACT=

Most of the currently known heterozygous pathogenic NFKB1 (Nuclear factor kappa B subunit 1) variants comprise deleterious defects such as severe truncations, internal deletions, and frameshift variants. Collectively, these represent the most frequent monogenic cause of common variable immunodeficiency (CVID) identified so far. NFKB1 encodes the transcription factor precursor p105 which undergoes limited proteasomal processing of its C-terminal half to generate the mature NF-κB subunit p50. Whereas p105/p50 haploinsufficiency due to devastating genetic damages and protein loss is a well-known disease mechanism, the pathogenic significance of numerous NFKB1 missense variants still remains uncertain and/or unexplored, due to the unavailability of accurate test procedures to confirm causality. In this study we functionally characterized 47 distinct missense variants residing within the N-terminal domains, thus affecting both proteins, the p105 precursor and the processed p50. Following transient overexpression of EGFP-fused mutant p105 and p50 in HEK293T cells, we used fluorescence microscopy, Western blotting, electrophoretic mobility shift assays (EMSA), and reporter assays to analyze their effects on subcellular localization, protein stability and precursor processing, DNA binding, and on the RelA-dependent target promoter activation, respectively. We found nine missense variants to cause harmful damage with intensified protein decay, while two variants left protein stability unaffected but caused a loss of the DNA-binding activity. Seven of the analyzed single amino acid changes caused ambiguous protein defects and four variants were associated with only minor adverse effects. For 25 variants, test results were indistinguishable from those of the wildtype controls, hence, their pathogenic impact remained elusive. In summary, we show that pathogenic missense variants affecting the Rel-homology domain may cause protein-decaying defects, thus resembling the disease-mechanisms of p105/p50 haploinsufficiency or may cause DNA-binding deficiency. However, rare variants (with a population frequency of less than 0.01%) with minor abnormalities or with neutral tests should still be considered as potentially pathogenic, until suitable tests have approved them being benign.