Chronic granulomatous disease: the solving of a clinical riddle at the molecular level

Chronic granulomatous disease is an uncommon inherited disorder of phagocytes in which the defective production of microbicidal oxidants leads to an enhanced susceptibility to bacterial and fungal infections. Despite the near uniform absence of the respiratory burst in CGD phagocytes, there is a striking clinical and genetic heterogeneity in this disorder. The recent elucidation of the molecular basis of CGD now provides an explanation for this heterogeneity. CGD is caused by a defect in any one of four components of NADPH oxidase, the enzyme responsible for the generation of the antimicrobial oxidants. X-linked inheritance is seen in approximately 65% of patients and results from mutations in the gene encoding the gp91-phox subunit of the cytochrome b558 component of the oxidase. The remaining 35% of patients inherit CGD in an autosomal recessive manner due to mutations in the genes encoding the remaining three oxidase components: p22-phox (chromosome 16), p47-phox (chromosome 7), and p67-phox (chromosome 1). Deletions, insertions, and point mutation leading to premature stop codons, amino acid substitutions, and splice site defects have all been identified. Most CGD patients have mutations unique to their families. The diversity of these mutations and the multiple genes affected provide an explanation for the clinical and genetic heterogeneity of CGD.