Life-threatening viral disease in a novel form of autosomal recessive IFNAR2 deficiency in the Arctic

Christopher J A Duncan*, Morten K Skouboe, Sophie Howarth, Anne K Hollensen, Rui Chen, Malene L Børresen, Benjamin J Thompson, Jarmila Stremenova Spegarova, Catherine F Hatton, Frederik F Stæger, Mette K Andersen, John Whittaker, Søren R Paludan, Sofie E Jørgensen, Martin K Thomsen, Jacob G Mikkelsen, Carsten Heilmann, Daniela Buhas, Nina F Øbro, Jakob T BayHanne V Marquart, M Teresa de la Morena, Joseph A Klejka, Matthew Hirschfeld, Line Borgwardt, Isabel Forss, Tania Masmas, Anja Poulsen, Francisco Noya, Guy Rouleau, Torben Hansen, Sirui Zhou, Anders Albrechtsen, Reza Alizadehfar, Eric J Allenspach, Sophie Hambleton, Trine H Mogensen*

*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

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Abstract

Type I interferons (IFN-I) play a critical role in human antiviral immunity, as demonstrated by the exceptionally rare deleterious variants of IFNAR1 or IFNAR2. We investigated five children from Greenland, Canada, and Alaska presenting with viral diseases, including life-threatening COVID-19 or influenza, in addition to meningoencephalitis and/or hemophagocytic lymphohistiocytosis following live-attenuated viral vaccination. The affected individuals bore the same homozygous IFNAR2 c.157T>C, p.Ser53Pro missense variant. Although absent from reference databases, p.Ser53Pro occurred with a minor allele frequency of 0.034 in their Inuit ancestry. The serine to proline substitution prevented cell surface expression of IFNAR2 protein, small amounts of which persisted intracellularly in an aberrantly glycosylated state. Cells exclusively expressing the p.Ser53Pro variant lacked responses to recombinant IFN-I and displayed heightened vulnerability to multiple viruses in vitro-a phenotype rescued by wild-type IFNAR2 complementation. This novel form of autosomal recessive IFNAR2 deficiency reinforces the essential role of IFN-I in viral immunity. Further studies are warranted to assess the need for population screening.

Original languageEnglish
Article numbere20212427
JournalThe Journal of Experimental Medicine
Volume219
Issue6
Number of pages22
ISSN0022-1007
DOIs
Publication statusPublished - Jun 2022

Keywords

  • Antiviral Agents/metabolism
  • COVID-19
  • Humans
  • Inheritance Patterns
  • Interferon Type I/genetics
  • Receptor, Interferon alpha-beta

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