{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T18:09:34Z","timestamp":1793210974621,"version":"4.5.0"},"reference-count":50,"publisher":"American Society of Hematology","issue":"5","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,3,10]]},"abstract":"<jats:sec>\n                    <jats:title>Abstract<\/jats:title>\n                    <jats:p>The transcription factor IKAROS plays an important role in lymphocyte development, differentiation, and as a tumor suppressor. To date, &amp;gt;70 IKAROS germ line heterozygous variants have been reported in patients with primary immunodeficiency (PID)\/inborn errors of immunity (IEI) and leukemia, and this number continues to grow. Germ line IKAROS loss- and gain-of-function mutations have been linked to immunodeficiency, immune dysregulation, and hematologic malignancies, with a broad spectrum of clinical manifestations. Routine next-generation sequencing approaches in patients with PID\/IEI have facilitated the identification of IKAROS variants, including several cases with variants of uncertain significance (VUS). To determine the VUS\u2019 functional behavior, we systematically generated constructs recapitulating those changes and tested IKAROS functions in vitro. We also conducted an in-depth examination of the C-terminal dimerization domain using alanine-scanning mutagenesis to identify amino acids critical for dimerization and other functions. This work provides a comprehensive description of the biologic impact of 81 previously unreported and\/or untested IKAROS variants, including 33 patient-detected germ line VUS and 48 laboratory-generated mutations in the dimerization domain. Among them, 15 of the patient-detected variants, primarily mapping to IKAROS DNA-binding or dimerization domains, and at least 21 of the laboratory-generated mutations, impaired IKAROS function and could explain or result in human disease. VUS located in between IKAROS DNA binding and dimerization domains were less likely to be functionally deleterious. Of note, both positive and negative functional data herein generated can be relevant for patients carrying these IKAROS variants, helping to establish a diagnosis and guide treatment decisions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1182\/bloodadvances.2025017243","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T20:55:47Z","timestamp":1765486547000},"page":"1522-1536","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":1,"title":["Systematic functional validation of IKAROS variants from patients and laboratory-generated mutations"],"prefix":"10.1182","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2154-3966","authenticated-orcid":false,"given":"Hye Sun","family":"Kuehn","sequence":"first","affiliation":[{"name":"1Immunology Service, Department of Laboratory Medicine, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5499-8000","authenticated-orcid":false,"given":"Agustin A.","family":"Gil Silva","sequence":"additional","affiliation":[{"name":"1Immunology Service, Department of Laboratory Medicine, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5077-2728","authenticated-orcid":false,"given":"Natchanun","family":"Klangkalya","sequence":"additional","affiliation":[{"name":"1Immunology Service, Department of Laboratory Medicine, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD"},{"name":"2Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Esteve-Sole","sequence":"additional","affiliation":[{"name":"1Immunology Service, Department of Laboratory Medicine, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shubham","family":"Goel","sequence":"additional","affiliation":[{"name":"1Immunology Service, Department of Laboratory Medicine, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie E.","family":"Niemela","sequence":"additional","affiliation":[{"name":"1Immunology Service, Department of Laboratory Medicine, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Stoddard","sequence":"additional","affiliation":[{"name":"1Immunology Service, Department of Laboratory Medicine, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hey","family":"Chong","sequence":"additional","affiliation":[{"name":"3Division of Allergy and Immunology, Department of Pediatrics, UPMC Children\u2019s Hospital of Pittsburgh, Pittsburgh, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2318-6023","authenticated-orcid":false,"given":"Kelli","family":"Williams","sequence":"additional","affiliation":[{"name":"4Division of Pediatric Pulmonology, Allergy and Immunology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Winnie","family":"Ip","sequence":"additional","affiliation":[{"name":"5Molecular and Cellular Immunology, UCL Great Ormond Street Institute of Child Health, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7355-3691","authenticated-orcid":false,"given":"Mario","family":"Framil Seoane","sequence":"additional","affiliation":[{"name":"6Immunology Department, Hospital Cl\u00ednic, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4036-666X","authenticated-orcid":false,"given":"Sathish Kumar","family":"Loganathan","sequence":"additional","affiliation":[{"name":"7Department of Pediatrics, Christian Medical College and Hospital, Vellore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariharan","family":"Anantharachagan","sequence":"additional","affiliation":[{"name":"8Department of Allergy and Clinical Immunology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United 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