Transduction, Transcription, and Translation: a practical framework for the pediatric pulmonary specialist for diagnosing and treating inborn errors of immunity

ABSTRACT

The expanding number of recognized inborn errors of immunity (IEIs), together with rapid advances in biologic, gene, and RNA-based therapies, has increased the diagnostic and conceptual complexity faced by practicing pediatric pulmonary specialists.

This article introduces a practical, biologically grounded framework – Transduction, Transcription, and Translation (“the Three T’s”) – to aid clinicians in understanding, classifying, and diagnosing IEIs.

The work is a conceptual synthesis of classic and contemporary IEIs based on the stage at which immune communication fails.

IEIs can be categorized as disorders of signal reception (Transduction), immune program selection (Transcription), or protein execution (Translation). Mapping disorders to this framework clarifies diagnostic reasoning and therapeutic implications.

In conclusion, the Three-T framework offers a clinically intuitive model for interpreting immune dysfunction and may facilitate the integration of emerging targeted therapies.

KEY WORDS

Transduction; transcription; translation; inborn errors; immunity.

IMPACT STATEMENT

The “Three-T” framework provides pediatric pulmonary specialists with a practical conceptual model for localizing immune dysfunction in inborn errors of immunity. The model facilitates diagnostic reasoning and helps clinicians integrate emerging biologic, gene, and RNA-based therapies into clinical practice.

Received: Apr 10, 2026
Accepted: May 22, 2026
Published: Jun 04, 2026