Immune cell functionality is highly dependent on the actin cytoskeleton. The actin cytoskeleton is regulated by a complex molecular machinery that involves multiple genes. Mutations in these genes can cause inborn errors of immunity, also termed immunoactinopathies, of which Wiskott-Aldrich syndrome is the best-characterized entity. Currently, mutations in 23 genes can be considered causative of immunoactinopathies. Immunoactinopathies are rare disease entities with complex combinations of clinical manifestations, including immunodeficiency, immune dysregulation, malignancies, atopy, thrombocytopenia and bleeding, skin involvement, or congenital defects. Prompt diagnosis is crucial, because hematopoietic stem cell transplantation in an early phase can offer cure and prevent further complications. This review provides a detailed summary of the clinical experience with immunoactinopathies so far, elaborates on the most distinguishing features of immunoactinopathies by providing a clinical categorization, and links this information to the underlying biological pathways. This information may be of help to clinicians in the diagnosis of patients and to eventually improve patient care.
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REVIEW ARTICLE|
June 5, 2025
Immunoactinopathies revisited: understanding clinical manifestations and biological pathways Available to Purchase
Fleur Hiensch,
Fleur Hiensch
1Department of Pediatrics, Laboratory for Pediatric Immunology, Willem-Alexander Children’s Hospital, Leiden University Medical Center, Leiden, The Netherlands
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Loïc Dupré,
Loïc Dupré
2Toulouse Institute for Infectious and Inflammatory Diseases, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, Toulouse University, Toulouse, France
3Department of Dermatology, Medical University of Vienna, Vienna, Austria
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Elisabeth Salzer
Elisabeth Salzer
1Department of Pediatrics, Laboratory for Pediatric Immunology, Willem-Alexander Children’s Hospital, Leiden University Medical Center, Leiden, The Netherlands
4Division of Neonatology, Pediatric Intensive Care, and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
5Department of Pediatrics, St. Anna Children’s Hospital, Medical University of Vienna, Vienna, Austria
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Blood (2025) 145 (23): 2709–2732.
Article history
Submitted:
September 3, 2024
Accepted:
February 3, 2025
First Edition:
February 19, 2025
Citation
Fleur Hiensch, Loïc Dupré, Elisabeth Salzer; Immunoactinopathies revisited: understanding clinical manifestations and biological pathways. Blood 2025; 145 (23): 2709–2732. doi: https://doi.org/10.1182/blood.2024026763
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