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Omenn syndrome does not live by V(D)J recombination alone

Marrella, Veronica; Maina, Virginia; Villa, Anna

Current Opinion in Allergy and Clinical Immunology: December 2011 - Volume 11 - Issue 6 - p 525–531
doi: 10.1097/ACI.0b013e32834c311a
Primary immune deficiency disease: Edited by Amos Etzioni and Ramsey Fuleihan

Purpose of review During the past decade, easy access to sequence analyses has allowed us to increase our understanding of the pathogenesis of severe combined immunodeficiencies. Here, we describe the expanding clinical and immunological spectrum associated with Omenn syndrome phenotype. In particular, we review the cellular and molecular mechanisms involved in the pathophysiology of ‘classical’ Omenn syndrome due to the recombination activating gene (RAG) defects and of a new subgroup of Omenn-like disorders.

Recent findings Different types of mutations are associated with the Omenn phenotype characterized by skin erythroderma, oligoclonal-activated T cells and elevated IgE in the absence of circulating B cells. Extensive studies conducted over the last few years have allowed the definition of the ‘classical form’ of Omenn syndrome due to hypomorphic defects in genes involved in V(D)J recombination, mainly RAG genes, and ‘Omenn-like’ features associated with mutations in genes involved in the maturation steps of lymphoid cells other than V(D)J recombination. Moreover, an increasing number of diseases other than those due to V(D)J recombination defects develop Omenn signs.

Summary Impaired but not abolished V(D)J recombination process leads to the generation of a few T cells which expand in the periphery, infiltrate target organs such as skin and gut, resulting in severe erythroderma and colitis, both typical signs of Omenn syndrome. Extensive molecular studies now demonstrate that genes other than V(D)J molecules have a role in the pathogenesis of this disease, supporting the evidence that ‘Omenn’ defines an inflammatory condition associated with various genetic defects.

aInstitute of Genetic and Biomedical Research, Milan Unit, National Research Council (CNR), Milan

bIstituto Clinico Humanitas IRCCS, Rozzano, Italy

Correspondence to Anna Villa, MD, Istituto Clinico Humanitas IRCCS, 20089 Rozzano, Italy E-mail:

Copyright © 2011 Wolters Kluwer Health, Inc. All rights reserved.