Test Id : VIRID

For skin biopsy or cultured fibroblast specimens, fibroblast culture will be performed at an additional charge. If viable cells are not obtained, the client will be notified.

For patients with Epstein-Barr virus (EBV) susceptibility or a heritable predisposition to lymphoproliferative diseases, see EBLPD / Epstein-Barr Virus (EBV) Susceptibility and Lymphoproliferative Disorders Gene Panel, Varies.

Targeted testing for familial variants (also called site-specific or known variants testing) is available for the genes on this panel. See FMTT / Familial Variant, Targeted Testing, Varies. To obtain more information about testing option, call 800-533-1710.

Specimen preferred to arrive within 96 hours of collection.

Patient Preparation: A previous bone marrow transplant from an allogenic donor will interfere with testing. Call 800-533-1710 for instructions for testing patients who have received a bone marrow transplant.

Submit only 1 of the following specimens:

Specimen Type: Whole blood

Container/Tube:

Preferred: Lavender top (EDTA) or yellow top (ACD)

Acceptable: Any anticoagulant

Specimen Volume: 3 mL

Collection Instructions:

1. Invert several times to mix blood.

2. Send whole blood specimen in original tube. Do not aliquot.

Specimen Stability Information: Ambient (preferred) 4 days/Refrigerated

Specimen Type: Skin biopsy

Supplies: Fibroblast Biopsy Transport Media (T115)

Container/Tube: Sterile container with any standard cell culture media (eg, minimal essential media, RPMI 1640). The solution should be supplemented with 1% penicillin and streptomycin.

Specimen Volume: 4-mm punch

Specimen Stability Information: Refrigerated (preferred)/Ambient

Additional Information: A separate culture charge will be assessed under CULFB /Fibroblast Culture for Biochemical or Molecular Testing. An additional 3 to 4 weeks is required to culture fibroblasts before genetic testing can occur.

Specimen Type: Cultured fibroblasts

Container/Tube: T-25 flask

Specimen Volume: 2 Flasks

Collection Instructions: Submit confluent cultured fibroblast cells from a skin biopsy from another laboratory. Cultured cells from a prenatal specimen will not be accepted.

Specimen Stability Information: Ambient (preferred)/Refrigerated (<24 hours)

Additional Information: A separate culture charge will be assessed under CULFB /Fibroblast Culture for Biochemical or Molecular Testing. An additional 3 to 4 weeks is required to culture fibroblasts before genetic testing can occur.

• Informed Consent for Genetic Testing
• Informed Consent for Genetic Testing (Spanish)
• Targeted Genes and Methodology Details for Viral Susceptibility, Defects in Intrinsic and Innate Immunity, Gene Panel
• Viral Susceptibility, Lymphoproliferation, and Hemophagocytic Lymphohistiocytosis Patient Information

1. New York Clients-Informed consent is required. Document on the request form or electronic order that a copy is on file. The following documents are available:

-Informed Consent for Genetic Testing (T576)

-Informed Consent for Genetic Testing (Spanish) (T826)

2. Molecular Genetics: Congenital Inherited Diseases Patient Information (T521)

3. Viral Susceptibility, Lymphoproliferation, and Hemophagocytic Lymphohistiocytosis Patient Information

Blood: 1 mL; Skin biopsy or cultured fibroblasts: See Specimen Required

Providing a comprehensive genetic evaluation for patients with a personal or family history suggestive of an inborn error of immunity causing a hereditary form of severe viral susceptibility

Establishing a diagnosis of hereditary form of viral susceptibility, allowing for appropriate management and surveillance for disease features based on the gene and/or variant involved

Identifying variants within genes known to be associated with a hereditary form of viral susceptibility, allowing for predictive testing of at-risk family members

This test utilizes next-generation sequencing to detect single nucleotide and copy number variants in 30 genes associated with a hereditary form of viral susceptibility: CARMIL2, CD27, CD70, CIB1, CTPS1, CXCR4, DBR1, IFIH1, IFNAR1, IFNAR2, IRF3, IRF7, IRF9, MAGT1, POLR3A, POLR3C, PRKCD, RASGRP1, SH2D1A, STAT1, STAT2, TLR3, TLR7, TLR8, TMC6, TMC8, TNFRSF9, TRAF3, UNC93B1, and XIAP. See Targeted Genes and Methodology Details for Viral Susceptibility, Defects in Intrinsic and Innate Immunity, Gene Panel and Method Description for additional details.

Identification of a disease-causing variant may assist with diagnosis, prognosis, clinical management, recurrence risk assessment, familial screening, and genetic counseling for a hereditary form of viral susceptibility.

For skin biopsy or cultured fibroblast specimens, fibroblast culture will be performed at an additional charge. If viable cells are not obtained, the client will be notified.

Viral infections are common in otherwise healthy individuals, but they may also present clinically due to a primary (genetic) immunodeficiency (ie, inborn error of immunity: IEI). Alternatively, secondary immunodeficiencies may have a similar presentation but result from immunosuppressive medication or illness, such as HIV infection. IEIs may cause a susceptibility to an entire group of pathogens (bacteria, fungi, or viruses), a subset of pathogens (eg, RNA viruses), or can cause susceptibility specific to a single pathogen (eg, Epstein-Barr virus [EBV], human papillomavirus [HPV]). IEIs may also lead to a more severe presentation, including fatal infection caused by a pathogen that usually causes only a mild or non-fatal disease (eg, influenza). This panel targets IEIs that lead to susceptibility to viruses or to a subset of viruses, severe viral pneumonia, or a specific virus. Examples of infections where this gene panel is useful include EBV, skin-tropic beta-HPV, influenza, and SARS-CoV-2. IEIs that lead to systemic immune deficiencies and susceptibility to a large variety of pathogens (eg, T-cell deficiencies) are not included in this panel.

EBV is the cause of infectious mononucleosis and persists asymptomatically for life in nearly all adults. It is also associated with the development of T- and B-cell lymphomas, nasopharyngeal and gastric carcinomas, and other malignancies. EBV infection in IEIs can present with fulminant infectious mononucleosis, hemophagocytosis, B-cell proliferative disease (including lymphoma), and hypogammaglobulinemia.

Beta-HPVs circulate silently in the general population and cause no visible lesions in most people. Genetic susceptibility to beta-HPVs leads to warts, pityriasis-like lesions, epidermodysplasia verruciformis, and increased risk of non-melanoma skin cancers.

Seasonal influenza viruses are common RNA viruses that infect the respiratory tract, causing a benign illness in most infected individuals. Influenza pneumonia or acute respiratory distress syndrome are rare, and the case fatality ratio is less than 1%. Children with severe influenza have been found to carry defects in IRF7, IRF9, STAT1, STAT2, and TLR3. Similarly, the COVID-19 pandemic has revealed that SARS-CoV-2 infection can lead to asymptomatic infection as well as fatal pneumonia. Genetic studies showed that approximately 2 to 3% of cases of severe life-threatening SARS-CoV-2 infection resulted from IEI, mainly genetic defects in the TLR3- or TLR7-dependent type 1 interferon pathway (eg, TLR3, TLR7, IFNAR1/2, STAT2, and IRF7), overlapping with that of severe pneumonia susceptibility in influenza infections.

An interpretive report will be provided.

All detected variants are evaluated according to American College of Medical Genetics and Genomics recommendations.(1) Variants are classified based on known, predicted, or possible pathogenicity and reported with interpretive comments detailing their potential or known significance.

Clinical Correlations:

Test results should be interpreted in the context of clinical findings, family history, and other laboratory data. Misinterpretation of results may occur if the information provided is inaccurate or incomplete.

If testing was performed because of a clinically significant family history, it is often useful to first test an affected family member. Detection of a reportable variant in an affected family member would allow for more informative testing of at-risk individuals.

To discuss the availability of additional testing options or for assistance in the interpretation of these results, contact Mayo Clinic Laboratories genetic counselors at 800-533-1710.

Technical Limitations:

Next-generation sequencing may not detect all types of genomic variants. In rare cases, false-negative or false-positive results may occur. The depth of coverage may be variable for some target regions; assay performance below the minimum acceptable criteria or for failed regions will be noted. Given these limitations, negative results do not rule out the diagnosis of a genetic disorder. If a specific clinical disorder is suspected, evaluation by alternative methods can be considered.

There may be regions of genes that cannot be effectively evaluated by sequencing or deletion and duplication analysis as a result of technical limitations of the assay, including regions of homology, high guanine-cytosine (GC) content, and repetitive sequences. Confirmation of select reportable variants will be performed by alternate methodologies based on internal laboratory criteria.

This test is validated to detect 95% of deletions up to 75 base pairs (bp) and insertions up to 47 bp. Deletions-insertions (delins) of 40 or more bp, including mobile element insertions, may be less reliably detected than smaller delins.

Deletion/Duplication Analysis:

This analysis targets single and multi-exon deletions/duplications; however, in some instances, single exon resolution cannot be achieved due to isolated reduction in sequence coverage or inherent genomic complexity. Balanced structural rearrangements (such as translocations and inversions) may not be detected.

This test is not designed to detect low levels of mosaicism or to differentiate between somatic and germline variants. If there is a possibility that any detected variant is somatic, additional testing may be necessary to clarify the significance of results.

Genes may be added or removed based on updated clinical relevance. Refer to the Targeted Genes and Methodology Details for Viral Susceptibility, Defects in Intrinsic and Innate Immunity, Gene Panel for the most up to date list of genes included in this test. For detailed information regarding gene-specific performance and technical limitations, see Method Description or contact a laboratory genetic counselor.

1. Richards S, Aziz N, Bale S, et al; ACMG Laboratory Quality Assurance Committee: Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology. Genet Med. 2015 May;17(5):405-424

2. Tangye SG, Al-Herz W, Bousfiha A, et al: Human inborn errors of immunity: 2022 update on the classification from the international union of immunological societies expert committee. J Clin Immunol. 2022 Jun 24:1–35. doi: 10.1007/s10875-022-01289-3

3. Casanova JL, Abel L: Mechanisms of viral inflammation and disease in humans. Science. 2021 Nov 26;374(6571):1080-1086. doi: 10.1126/science.abj7965

4. Zhang Q, Bastard P; COVID Human Genetic Effort, Cobat A, Casanova JL: Human genetic and immunological determinants of critical COVID-19 pneumonia. Nature. 2022 Mar;603(7902):587-598. doi: 10.1038/s41586-022-04447-0

5. Fournier B, Latour S: Immunity to EBV as revealed by immunedeficiencies. Curr Opin Immunol. 2021 Oct;72:107-115. doi: 10.1016/j.coi.2021.04.003

6. Beziat V, Casanova JL, Jouanguy E: Human genetic and immunological dissection of papillomavirus-driven diseases: new insights into their pathogenesis. Curr Opin Virol. 2021 Dec;51:9-15. doi: 10.1016/j.coviro.2021.09.002

Next-generation sequencing (NGS) and/or Sanger sequencing are performed to test for the presence of variants in coding regions and intron/exon boundaries of the genes analyzed, as well as some other regions that have known disease-causing variants. The human genome reference GRCh37/hg19 build was used for sequence read alignment. At least 99% of the bases are covered at a read depth over 30X. Sensitivity is estimated at above 99% for single nucleotide variants, above 94% for deletions/insertions (delins) less than 40 base pairs (bp), and above 95% for deletions up to 75 bp and insertions up to 47 bp. NGS and/or a polymerase chain reaction-based quantitative method is performed to test for the presence of deletions and duplications in the genes analyzed.

Varies

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• Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
• Prospective clients should contact their account representative. For assistance, contact Customer Service.

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.

81443

88233-Tissue culture, skin, solid tissue biopsy (if appropriate)

88240-Cryopreservation (if appropriate)