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Inherited Ifnar1 Deficiency in a Child With Both Critical Covid-19 Pneumonia and Multisystem Inflammatory Syndrome Publisher Pubmed



Abolhassani H1, 2 ; Landegren N3, 4 ; Bastard P5, 6, 7 ; Materna M6, 7 ; Modaresi M8 ; Du L1 ; Arandaguillen M3 ; Sardh F3, 4 ; Zuo F1 ; Zhang P5 ; Marcotte H9 ; Marr N10, 11 ; Khan T10 ; Ata M10 Show All Authors
Authors
  1. Abolhassani H1, 2
  2. Landegren N3, 4
  3. Bastard P5, 6, 7
  4. Materna M6, 7
  5. Modaresi M8
  6. Du L1
  7. Arandaguillen M3
  8. Sardh F3, 4
  9. Zuo F1
  10. Zhang P5
  11. Marcotte H9
  12. Marr N10, 11
  13. Khan T10
  14. Ata M10
  15. Alali F10
  16. Pescarmona R12, 13
  17. Belot A12, 14, 15
  18. Beziat V6, 7
  19. Zhang Q5, 6
  20. Casanova JL5, 6, 7, 16
  21. Kampe O4, 17
  22. Zhang SY5, 6, 7
  23. Hammarstrom L1
  24. Panhammarstrom Q1

Source: Journal of Clinical Immunology Published:2022


Abstract

Background: Inborn errors of immunity (IEI) and autoantibodies to type I interferons (IFNs) underlie critical COVID-19 pneumonia in at least 15% of the patients, while the causes of multisystem inflammatory syndrome in children (MIS-C) remain elusive. Objectives: To detect causal genetic variants in very rare cases with concomitant critical COVID-19 pneumonia and MIS-C. Methods: Whole exome sequencing was performed, and the impact of candidate gene variants was investigated. Plasma levels of cytokines, specific antibodies against the virus, and autoantibodies against type I IFNs were also measured. Results: We report a 3-year-old child who died on day 56 of SARS-CoV-2 infection with an unusual clinical presentation, combining both critical COVID-19 pneumonia and MIS-C. We identified a large, homozygous loss-of-function deletion in IFNAR1, underlying autosomal recessive IFNAR1 deficiency. Conclusions: Our findings confirm that impaired type I IFN immunity can underlie critical COVID-19 pneumonia, while suggesting that it can also unexpectedly underlie concomitant MIS-C. Our report further raises the possibility that inherited or acquired dysregulation of type I IFN immunity might contribute to MIS-C in other patients. © 2022, The Author(s).
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