Severe influenza pneumonitis in children with inherited TLR3 deficiency

HK Lim, SXL Huang, J Chen, G Kerner… - Journal of Experimental …, 2019 - rupress.org
HK Lim, SXL Huang, J Chen, G Kerner, O Gilliaux, P Bastard, K Dobbs, N Hernandez…
Journal of Experimental Medicine, 2019rupress.org
Autosomal recessive IRF7 and IRF9 deficiencies impair type I and III IFN immunity and
underlie severe influenza pneumonitis. We report three unrelated children with influenza A
virus (IAV) infection manifesting as acute respiratory distress syndrome (IAV-ARDS),
heterozygous for rare TLR3 variants (P554S in two patients and P680L in the third) causing
autosomal dominant (AD) TLR3 deficiency. AD TLR3 deficiency can underlie herpes
simplex virus-1 (HSV-1) encephalitis (HSE) by impairing cortical neuron-intrinsic type I IFN …
Autosomal recessive IRF7 and IRF9 deficiencies impair type I and III IFN immunity and underlie severe influenza pneumonitis. We report three unrelated children with influenza A virus (IAV) infection manifesting as acute respiratory distress syndrome (IAV-ARDS), heterozygous for rare TLR3 variants (P554S in two patients and P680L in the third) causing autosomal dominant (AD) TLR3 deficiency. AD TLR3 deficiency can underlie herpes simplex virus-1 (HSV-1) encephalitis (HSE) by impairing cortical neuron-intrinsic type I IFN immunity to HSV-1. TLR3-mutated leukocytes produce normal levels of IFNs in response to IAV. In contrast, TLR3-mutated fibroblasts produce lower levels of IFN-β and -λ, and display enhanced viral susceptibility, upon IAV infection. Moreover, the patients’ iPSC-derived pulmonary epithelial cells (PECs) are susceptible to IAV. Treatment with IFN-α2b or IFN-λ1 rescues this phenotype. AD TLR3 deficiency may thus underlie IAV-ARDS by impairing TLR3-dependent, type I and/or III IFN–mediated, PEC-intrinsic immunity. Its clinical penetrance is incomplete for both IAV-ARDS and HSE, consistent with their typically sporadic nature.
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