Respiratory viral infections in otherwise healthy humans with inherited IRF7 deficiency.

Respiratory viral infections in otherwise healthy humans with inherited IRF7 deficiency.
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DOI:
10.1084/jem.20220202
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发表时间:
2022-07-04
期刊:
The Journal of experimental medicine
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其他
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坎贝尔等人。描述了七名患有严重呼吸道病毒感染的 IRF7 缺陷患者。结合遗传、免疫学和临床研究,他们强调了 IRF7 缺陷的疾病易感性惊人地狭窄,并揭示了潜在的补偿性免疫机制,包括 IFN-β 和适应性免疫。此前曾报道过三名单次危重流感或 COVID-19 肺炎发作患者存在常染色体隐性 IRF7 缺陷。患者的成纤维细胞和浆细胞样树突状细胞不产生可检测到的 I 型和 III 型干扰素(IFN-β 除外)。在发现了四名新患者后,我们描述了来自六个家庭和五个祖先的七名 IRF7 缺陷患者的遗传、免疫学和临床特征。五个是 IRF7 变体的纯合子,两个是复合杂合子。患者通常患有一次肺部病毒性疾病。发病年龄惊人地广泛,从 6 个月到 50 岁(平均年龄 29 岁)。涉及的呼吸道病毒包括SARS-CoV-2、流感病毒、呼吸道合胞病毒和腺病毒。血清学分析表明以前感染过许多常见病毒。细胞分析显示出强大的抗病毒免疫力以及流感和 SARS-CoV-2 特异性记忆 CD4+ 和 CD8+ T 细胞数量的增加。 IRF7 缺陷的个体容易发生呼吸道病毒感染,但在其他方面却很健康,这可能是由于残留的 IFN-β 和补偿性适应性免疫。
Campbell et al. describe seven IRF7-deficient patients with severe respiratory viral infection. Combining genetic, immunological, and clinical investigation, they highlight the surprisingly narrow disease susceptibility of IRF7 deficiency and reveal potential compensatory immunological mechanisms, including IFN-β and adaptive immunity. Autosomal recessive IRF7 deficiency was previously reported in three patients with single critical influenza or COVID-19 pneumonia episodes. The patients’ fibroblasts and plasmacytoid dendritic cells produced no detectable type I and III IFNs, except IFN-β. Having discovered four new patients, we describe the genetic, immunological, and clinical features of seven IRF7-deficient patients from six families and five ancestries. Five were homozygous and two were compound heterozygous for IRF7 variants. Patients typically had one episode of pulmonary viral disease. Age at onset was surprisingly broad, from 6 mo to 50 yr (mean age 29 yr). The respiratory viruses implicated included SARS-CoV-2, influenza virus, respiratory syncytial virus, and adenovirus. Serological analyses indicated previous infections with many common viruses. Cellular analyses revealed strong antiviral immunity and expanded populations of influenza- and SARS-CoV-2–specific memory CD4+ and CD8+ T cells. IRF7-deficient individuals are prone to viral infections of the respiratory tract but are otherwise healthy, potentially due to residual IFN-β and compensatory adaptive immunity.
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