Mild COVID-19 despite autoantibodies against type I IFNs in autoimmune polyendocrine syndrome type 1

Autoantibodies against IFN-alpha and IFN-omega (type I IFNs) were recently reported as causative for severe COVID-19 in the general population. Autoantibodies against IFN-alpha and IFN-omega are present in almost all patients with autoimmune polyendocrine syndrome type 1 (APS-1) caused by biallelic deleterious or heterozygous dominant mutations in AIRE. We therefore hypothesized that autoantibodies against type I IFNs also predispose patients with APS-1 to severe COVID-19. We prospectively studied 6 patients with APS-1 between April 1, 2020 and April 1, 2021. Biobanked pre-COVID-19 sera of APS-1 subjects were tested for neutralizing autoantibodies against IFN-alpha and IFN-omega. The ability of the patients' sera to block recombinant human IFN-alpha and IFN-omega was assessed by assays quantifying phosphorylation of signal transducer and activator of transcription 1 (STAT1) as well as infection-based IFN-neutralization assays. We describe 4 patients with APS-1 and preexisting high titers of neutralizing autoantibodies against IFN-alpha and IFN-omega who contracted SARS-CoV-2, yet developed only mild symptoms of COVID-19. None of the patients developed dyspnea, oxygen requirement, or high temperature. All infected patients with APS-1 were females and younger than 26 years of age. Clinical penetrance of neutralizing autoantibodies against type I IFNs for severe COVID-19 is not complete.

Automated summary

This study found that patients with APS-1 and preexisting neutralizing autoantibodies against IFN-alpha and IFN-omega developed only mild symptoms of COVID-19 after contracting SARS-CoV-2, without progressing to severe cases. These patients were mostly female and under the age of 26.