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患者存在独特形式的 IFNAR1 遗传性缺陷,引发单纯疱疹病毒性脑炎。

Herpes simplex encephalitis in a patient with a distinctive form of inherited IFNAR1 deficiency.

机构信息

Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Paris, France.

University of Paris, Imagine Institute, Paris, France.

出版信息

J Clin Invest. 2021 Jan 4;131(1). doi: 10.1172/JCI139980.

Abstract

Inborn errors of TLR3-dependent IFN-α/β- and IFN-λ-mediated immunity in the CNS can underlie herpes simplex virus 1 (HSV-1) encephalitis (HSE). The respective contributions of IFN-α/β and IFN-λ are unknown. We report a child homozygous for a genomic deletion of the entire coding sequence and part of the 3'-UTR of the last exon of IFNAR1, who died of HSE at the age of 2 years. An older cousin died following vaccination against measles, mumps, and rubella at 12 months of age, and another 17-year-old cousin homozygous for the same variant has had other, less severe, viral illnesses. The encoded IFNAR1 protein is expressed on the cell surface but is truncated and cannot interact with the tyrosine kinase TYK2. The patient's fibroblasts and EBV-B cells did not respond to IFN-α2b or IFN-β, in terms of STAT1, STAT2, and STAT3 phosphorylation or the genome-wide induction of IFN-stimulated genes. The patient's fibroblasts were susceptible to viruses, including HSV-1, even in the presence of exogenous IFN-α2b or IFN-β. HSE is therefore a consequence of inherited complete IFNAR1 deficiency. This viral disease occurred in natural conditions, unlike those previously reported in other patients with IFNAR1 or IFNAR2 deficiency. This experiment of nature indicates that IFN-α/β are essential for anti-HSV-1 immunity in the CNS.

摘要

先天性 TLR3 依赖性 IFN-α/β 和 IFN-λ介导的免疫缺陷可导致单纯疱疹病毒 1(HSV-1)脑炎(HSE)。然而,IFN-α/β 和 IFN-λ 的各自贡献尚不清楚。我们报告了一例儿童携带 IFNAR1 最后一个外显子的整个编码序列和部分 3'-UTR 缺失的纯合子,该儿童在 2 岁时死于 HSE。其 12 个月大时因接种麻疹、腮腺炎和风疹疫苗而死亡的年长表亲,以及另一位携带相同变异的 17 岁表亲,也患有其他不太严重的病毒性疾病。编码的 IFNAR1 蛋白在细胞表面表达,但截短且无法与酪氨酸激酶 TYK2 相互作用。该患者的成纤维细胞和 EBV-B 细胞在 STAT1、STAT2 和 STAT3 磷酸化或 IFN 刺激基因的全基因组诱导方面均未对 IFN-α2b 或 IFN-β 产生反应。即使存在外源性 IFN-α2b 或 IFN-β,该患者的成纤维细胞仍易受病毒感染,包括 HSV-1。因此,HSE 是由先天性 IFNAR1 缺陷引起的。与先前报道的其他 IFNAR1 或 IFNAR2 缺陷患者不同,这种病毒病是在自然条件下发生的。该自然实验表明,IFN-α/β 对于中枢神经系统抗 HSV-1 免疫至关重要。

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