@article {1017, title = {Preexisting autoantibodies to type I IFNs underlie critical COVID-19 pneumonia in patients with APS-1.}, journal = {J Exp Med}, volume = {218}, year = {2021}, month = {2021 07 05}, abstract = {

Patients with biallelic loss-of-function variants of AIRE suffer from autoimmune polyendocrine syndrome type-1 (APS-1) and produce a broad range of autoantibodies (auto-Abs), including circulating auto-Abs neutralizing most type I interferons (IFNs). These auto-Abs were recently reported to account for at least 10\% of cases of life-threatening COVID-19 pneumonia in the general population. We report 22 APS-1 patients from 21 kindreds in seven countries, aged between 8 and 48 yr and infected with SARS-CoV-2 since February 2020. The 21 patients tested had auto-Abs neutralizing IFN-α subtypes and/or IFN-ω; one had anti-IFN-β and another anti-IFN-ε, but none had anti-IFN-κ. Strikingly, 19 patients (86\%) were hospitalized for COVID-19 pneumonia, including 15 (68\%) admitted to an intensive care unit, 11 (50\%) who required mechanical ventilation, and four (18\%) who died. Ambulatory disease in three patients (14\%) was possibly accounted for by prior or early specific interventions. Preexisting auto-Abs neutralizing type I IFNs in APS-1 patients confer a very high risk of life-threatening COVID-19 pneumonia at any age.

}, keywords = {Adolescent, Adult, Autoantibodies, Child, COVID-19, Female, Humans, Interferon Type I, Male, Middle Aged, Pneumonia, Polyendocrinopathies, Autoimmune, SARS-CoV-2, Young Adult}, issn = {1540-9538}, doi = {10.1084/jem.20210554}, author = {Bastard, Paul and Orlova, Elizaveta and Sozaeva, Leila and L{\'e}vy, Romain and James, Alyssa and Schmitt, Monica M and Ochoa, Sebastian and Kareva, Maria and Rodina, Yulia and Gervais, Adrian and Le Voyer, Tom and Rosain, J{\'e}r{\'e}mie and Philippot, Quentin and Neehus, Anna-Lena and Shaw, Elana and Migaud, M{\'e}lanie and Bizien, Lucy and Ekwall, Olov and Berg, Stefan and Beccuti, Guglielmo and Ghizzoni, Lucia and Thiriez, G{\'e}rard and Pavot, Arthur and Goujard, C{\'e}cile and Fr{\'e}mond, Marie-Louise and Carter, Edwin and Rothenbuhler, Anya and Linglart, Agn{\`e}s and Mignot, Brigite and Comte, Aur{\'e}lie and Cheikh, Nathalie and Hermine, Olivier and Breivik, Lars and Husebye, Eystein S and Humbert, S{\'e}bastien and Rohrlich, Pierre and Coaquette, Alain and Vuoto, Fanny and Faure, Karine and Mahlaoui, Nizar and Kotnik, Primo{\v z} and Battelino, Tadej and Trebu{\v s}ak Podkraj{\v s}ek, Katarina and Kisand, Kai and Ferr{\'e}, Elise M N and DiMaggio, Thomas and Rosen, Lindsey B and Burbelo, Peter D and McIntyre, Martin and Kann, Nelli Y and Shcherbina, Anna and Pavlova, Maria and Kolodkina, Anna and Holland, Steven M and Zhang, Shen-Ying and Crow, Yanick J and Notarangelo, Luigi D and Su, Helen C and Abel, Laurent and Anderson, Mark S and Jouanguy, Emmanuelle and Neven, B{\'e}n{\'e}dicte and Puel, Anne and Casanova, Jean-Laurent and Lionakis, Michail S} } @article {607, title = {Hypomorphic caspase activation and recruitment domain 11 (CARD11) mutations associated with diverse immunologic phenotypes with or without atopic disease.}, journal = {J Allergy Clin Immunol}, volume = {143}, year = {2019}, month = {2019 Apr}, pages = {1482-1495}, abstract = {

BACKGROUND: Caspase activation and recruitment domain 11 (CARD11) encodes a scaffold protein in lymphocytes that links antigen receptor engagement with downstream signaling to nuclear factor κB, c-Jun N-terminal kinase, and mechanistic target of rapamycin complex 1. Germline CARD11 mutations cause several distinct primary immune disorders in human subjects, including severe combined immune deficiency (biallelic null mutations), B-cell expansion with nuclear factor κB and T-cell anergy (heterozygous, gain-of-function mutations), and severe atopic disease (loss-of-function, heterozygous, dominant interfering mutations), which has focused attention on CARD11 mutations discovered by using whole-exome sequencing.

OBJECTIVES: We sought to determine the molecular actions of an extended allelic series of CARD11 and to characterize the expanding range of clinical phenotypes associated with heterozygous CARD11 loss-of-function alleles.

METHODS: Cell transfections and primary T-cell assays were used to evaluate signaling and function of CARD11 variants.

RESULTS: Here we report on an expanded cohort of patients harboring novel heterozygous CARD11 mutations that extend beyond atopy to include other immunologic phenotypes not previously associated with CARD11 mutations. In addition to (and sometimes excluding) severe atopy, heterozygous missense and indel mutations in CARD11 presented with immunologic phenotypes similar to those observed in signal transducer and activator of transcription 3 loss of function, dedicator of cytokinesis 8 deficiency, common variable immunodeficiency, neutropenia, and immune dysregulation, polyendocrinopathy, enteropathy, X-linked-like syndrome. Pathogenic variants exhibited dominant negative activity and were largely confined to the CARD or coiled-coil domains of the CARD11 protein.

CONCLUSION: These results illuminate a broader phenotypic spectrum associated with CARD11 mutations in human subjects and underscore the need for functional studies to demonstrate that rare gene variants encountered in expected and unexpected phenotypes must nonetheless be validated for pathogenic activity.

}, issn = {1097-6825}, doi = {10.1016/j.jaci.2018.08.013}, author = {Dorjbal, Batsukh and Stinson, Jeffrey R and Ma, Chi A and Weinreich, Michael A and Miraghazadeh, Bahar and Hartberger, Julia M and Frey-Jakobs, Stefanie and Weidinger, Stephan and Moebus, Lena and Franke, Andre and Sch{\"a}ffer, Alejandro A and Bulashevska, Alla and Fuchs, Sebastian and Ehl, Stephan and Limaye, Sandhya and Arkwright, Peter D and Briggs, Tracy A and Langley, Claire and Bethune, Claire and Whyte, Andrew F and Alachkar, Hana and Nejentsev, Sergey and DiMaggio, Thomas and Nelson, Celeste G and Stone, Kelly D and Nason, Martha and Brittain, Erica H and Oler, Andrew J and Veltri, Daniel P and Leahy, T Ronan and Conlon, Niall and Poli, Maria C and Borzutzky, Arturo and Cohen, Jeffrey I and Davis, Joie and Lambert, Michele P and Romberg, Neil and Sullivan, Kathleen E and Paris, Kenneth and Freeman, Alexandra F and Lucas, Laura and Chandrakasan, Shanmuganathan and Savic, Sinisa and Hambleton, Sophie and Patel, Smita Y and Jordan, Michael B and Theos, Amy and Lebensburger, Jeffrey and Atkinson, T Prescott and Torgerson, Troy R and Chinn, Ivan K and Milner, Joshua D and Grimbacher, Bodo and Cook, Matthew C and Snow, Andrew L} }