Journal
JOURNAL OF CLINICAL IMMUNOLOGY
Volume 42, Issue 1, Pages 1-9Publisher
SPRINGER/PLENUM PUBLISHERS
DOI: 10.1007/s10875-021-01151-y
Keywords
COVID-19; critical COVID-19; inborn errors of immunity; primary immunodeficiency; antibody deficiency; ataxia-telangiectasia; ATM; TLR7
Categories
Funding
- Karolinska Institute
- European Union's Horizon 2020 research and innovation program (ATAC) [101003650]
- Center for Innovative Medicine at Karolinska Institutet
- Swedish Research Council
- Swedish Cancer Society
- Knut and Alice Wallenberg Foundation (KAW)
- National Institutes of Health (NIH) [R01AI088364]
- National Center for Advancing Translational Sciences (NCATS)
- NIH Clinical and Translational Science Award (CTSA) program [UL1TR001866]
- Emergent Ventures
- Mercatus Center at George Mason University
- Fisher Center for Alzheimer's Research Foundation
- Meyer Foundation
- JPB Foundation
- French National Research Agency (ANR) under the Investments for the Future program [ANR-10-IAHU-01]
- ANR [ANR-14-CE14-0008-01, ANR-18-CE15-0020-02, ANR-20-CO11-0001]
- French Foundation for Medical Research (FRM) [EQU201903007798]
- FRM
- ANR GENCOVID project [ANR-20-COVI-0003]
- ANRS Nord-Sud [ANRS-COV05]
- Square Foundation
- Grandir-Fonds de solidarite pour l'enfance
- SCOR Corporate Foundation for Science
- Howard Hughes Medical Institute
- Rockefeller University
- St. Giles Foundation
- Fondation du Souffle
- Institut National de la Sante et de la Recherche Medicale (INSERM)
- University of Paris
- Integrative Biology of Emerging Infectious Diseases Laboratory of Excellence [ANR-10-LABX-62-IBEID]
- Agence Nationale de la Recherche (ANR) [ANR-14-CE14-0008, ANR-20-COVI-0003, ANR-18-CE15-0020] Funding Source: Agence Nationale de la Recherche (ANR)
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This study identified a unique case of a patient with a preexisting inborn error of immunity (IEI) who developed critical COVID-19 pneumonia. Genetic analysis revealed homozygous deleterious mutations in the ATM gene and a hemizygous deleterious mutation in the TLR7 gene, underlying Ataxia-Telangiectasia (A-T) and critical COVID-19 in this patient. Among other A-T patients evaluated, SARS-CoV-2 infection resulted in mild symptoms or asymptomatic cases, highlighting the importance of genetic factors in COVID-19 severity.
Background Coronavirus disease 2019 (COVID-19) exhibits a wide spectrum of clinical manifestations, ranging from asymptomatic to critical conditions. Understanding the mechanism underlying life-threatening COVID-19 is instrumental for disease prevention and treatment in individuals with a high risk. Objectives We aimed to identify the genetic cause for critical COVID-19 pneumonia in a patient with a preexisting inborn error of immunity (IEI). Methods Serum levels of specific antibodies against the virus and autoantibodies against type I interferons (IFNs) were measured. Whole exome sequencing was performed, and the impacts of candidate gene variants were investigated. We also evaluated 247 ataxia-telangiectasia (A-T) patients in the Iranian IEI registry. Results We report a 7-year-old Iranian boy with a preexisting hyper IgM syndrome who developed critical COVID-19 pneumonia. IgM only specific COVID-19 immune response was detected but no autoantibodies against type I IFN were observed. A homozygous deleterious mutation in the ATM gene was identified, which together with his antibody deficiency, radiosensitivity, and neurological signs, established a diagnosis of A-T. Among the 247 A-T patients evaluated, 36 had SARS-CoV-2 infection, but all had mild symptoms or were asymptomatic except the index patient. A hemizygous deleterious mutation in the TLR7 gene was subsequently identified in the patient. Conclusions We report a unique IEI patient with combined ATM and TLR7 deficiencies. The two genetic defects underlie A-T and critical COVID-19 in this patient, respectively.
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