HAX1 deficiency causes autosomal recessive severe congenital neutropenia (Kostmann disease)

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Abstract
Autosomal recessive severe congenital neutropenia (SCN)1 constitutes a primary immunodeficiency syndrome associated with increased apoptosis in myeloid cells2,3, yet the underlying genetic defect remains unknown. Using a positional cloning approach and candidate gene evaluation, we identified a recurrent homozygous germline mutation in HAX1 in three pedigrees. After further molecular screening of individuals with SCN, we identified 19 additional affected individuals with homozygous HAX1 mutations, including three belonging to the original pedigree described by Kostmann1. HAX1 encodes the mitochondrial protein HAX1, which has been assigned functions in signal transduction4 and cytoskeletal control5,6. Here, we show that HAX1 is critical for maintaining the inner mitochondrial membrane potential and protecting against apoptosis in myeloid cells. Our findings suggest that HAX1 is a major regulator of myeloid homeostasis and underline the significance of genetic control of apoptosis in neutrophil development.