Adenosine deaminase deficiency

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Adenosine deaminase deficiency, also called ADA deficiency or ADA-SCID,^[1] is an autosomal recessive^[2] metabolic disorder that causes immunodeficiency.

It accounts for about 15% of all cases of severe combined immunodeficiency (SCID).^[3]

ADA deficiency may be present in infancy, childhood, adolescense, or adulthood.^[1] Age of onset and severity is related to some 29 known genotypes associated with the disorder.^[4]

Pathophysiology and Genetics

Adenosine deaminase deficiency has an autosomal recessive pattern of inheritance.

ADA deficiency is due to a lack of the enzyme adenosine deaminase, encoded by a gene on chromosome 20. There is an accumulation of deoxyadenosine,^[5] which causes an increase in S-adenosylhomocysteine since the enzyme adenosine deaminase is important in the purine salvage pathway.; both substances are toxic to immature lymphocytes, which thus fail to mature. This deficiency causes a build up of nucleotide metabolites in all cells, but this buildup it specifically detrimental to developing T cells and B cells. It is more detrimental to T cells, and causes affected individuals to have a small, underdeveloped thymus^[6]. As a result, the immune system is severely compromised or completely lacking.

ADA deficiency is inherited in an autosomal recessive manner.^[1] This means the defective gene responsible for the disorder is located on an autosome (chromosome 20 is an autosome), and two copies of the defective gene (one inherited from each parent) are required in order to be born with the disorder. The parents of an individual with an autosomal recessive disorder both carry one copy of the defective gene, but usually do not experience any signs or symptoms of the disorder.

Treatment

Treatments include:

• bone marrow transplant
• gene therapy
• ADA enzyme in PEG vehicle

On September 14, 1990,the first gene therapy to combat this disease was performed by Dr. W. French Anderson on a four year old girl, Ashanti DeSilva, at the National Institutes of Health, Bethesda, Maryland, U.S.A.^[7]

References

External links

• Adenosine deaminase deficiency - Genetics Home Reference
• Gene Therapy Net

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