4/ Note that the Journal of Clinical Immunology, the international journal in the field of inborn errors of immunity, has been at the forefront of research on #COVID19 and #autoAbs to #type1IFN. Guess why 😊
5/ The proportion of patients with critical C-19 due to pre-existing #autoAbs to #type1IFN would be probably even higher if lower, more physiological concentrations of #type1IFN were considered (science.org/doi/10.1126/sc…).
1/ In this 2nd @SciImmunology paper (immunology.sciencemag.org/content/6/62/e…), we show pre-existing auto-Abs neutralizing low physiological concentrations of type I IFNs account for 15% of critical COVID-19 cases, including 20% of critical cases in patients >80 yrs and 20% of deaths across ages.
2/ We tested 100-fold lower concentrations of type I IFN than in our previous report (science.sciencemag.org/content/370/65…). We also found that, in most patients, these auto-Abs neutralize IFN-alphas and/or -omega, while other patients carry auto-Abs that neutralize IFN-beta only.
3/ The penetrance for critical COVID-19 pneumonia is high, but depends on the nature of the auto-Abs (e.g. neutralization of both IFN-alphas and -omega versus -omega only), as indicated by the varying odds ratios.
1/ In this first @SciImmunology paper (immunology.sciencemag.org/content/6/62/e…), we show that at least 1% of men younger than 60 years with life-threatening COVID-19 are sick because of X-linked recessive (XR) TLR7 deficiency.
2/ In an unbiased burden test, we found TLR7 as the most significant hit on the X chromosome; with very rare (MAF<10e-4) nonsynonymous variants found in patients with critical COVID-19, but not in patients with asymptomatic/mild infection.
3/ By testing all known TLR7 variants, we found that only 4 of the 8 previously reported TLR7 variants in COVID-19 patients are LOF, and that the cumulative MAF of LOF variants in men in the general population is < 6.5x10e-4.
We report @JExpMed an international survey of SARS-CoV-2-infected APS-1 patients and show that they are at very high risk of life-threatening, critical C-19 pneumonia due to preexisting auto-Abs neutralizing type I IFNs (urldefense.proofpoint.com/v2/url?u=https…)
APS-1 patients typically carry bi-allelic mutations in 𝘈𝘐𝘙𝘌, which controls thymic expression of peripheral antigens, thereby governing central T cell tolerance (science.sciencemag.org/content/298/55…).
We show that neutralizing autoantibodies to type I IFNs underlie a third of the life-threatening adverse reactions to yellow fever virus live-attenuated virus (YFV 17D): rupress.org/jem/article/21…
We also report a patient with YFV 17D disease due to inherited IFNAR2 deficiency, consistent with our previous description of a patient with inherited IFNAR1 deficiency: rupress.org/jem/article/21…
These studies indicate that at least half of the rare but devastating cases of YFV 17D disease are due to inborn errors of type I IFN immunity or their autoimmune phenocopy.
We have been silent for a while because our lab and the CHGE were entirely focused on finishing 'twin papers' in @ScienceMagazine about inborn errors of type I IFN or auto-antibodies to type I IFN in nearly 15% of patients with life-threatening #COVID19 😀 science.sciencemag.org/content/369/65…
Here is the first paper, which shows that variants in only 13 influenza susceptibility candidate genes that govern TLR3- and IRF7-dependent production of type I IFNs account for at least 3.5% of critical cases of #COVID19science.sciencemag.org/content/early/…@ScienceMagazine
Here is the other paper, which shows that neutralizing auto-Abs to type I IFNs account for at least 10% of critical cases of #COVID19, even in a greater proportion in men: an auto-immune phenocopy of the corresponding inborn errors science.sciencemag.org/content/early/…@ScienceMagazine