Inborn errors of TLR3-or MDA5-dependent type I IFN immunity in children with enterovirus rhombencephalitis

J Chen, H Jing, A Martin-Nalda, P Bastard… - Journal of Experimental …, 2021 - rupress.org
J Chen, H Jing, A Martin-Nalda, P Bastard, JG Rivière, Z Liu, R Colobran, D Lee, W Tung
Journal of Experimental Medicine, 2021rupress.org
Enterovirus (EV) infection rarely results in life-threatening infection of the central nervous
system. We report two unrelated children with EV30 and EV71 rhombencephalitis. One
patient carries compound heterozygous TLR3 variants (loss-of-function F322fs2* and
hypomorphic D280N), and the other is homozygous for an IFIH1 variant (loss-of-function c.
1641+ 1G> C). Their fibroblasts respond poorly to extracellular (TLR3) or intracellular
(MDA5) poly (I: C) stimulation. The baseline (TLR3) and EV-responsive (MDA5) levels of IFN …
Enterovirus (EV) infection rarely results in life-threatening infection of the central nervous system. We report two unrelated children with EV30 and EV71 rhombencephalitis. One patient carries compound heterozygous TLR3 variants (loss-of-function F322fs2* and hypomorphic D280N), and the other is homozygous for an IFIH1 variant (loss-of-function c.1641+1G>C). Their fibroblasts respond poorly to extracellular (TLR3) or intracellular (MDA5) poly(I:C) stimulation. The baseline (TLR3) and EV-responsive (MDA5) levels of IFN-β in the patients’ fibroblasts are low. EV growth is enhanced at early and late time points of infection in TLR3- and MDA5-deficient fibroblasts, respectively. Treatment with exogenous IFN-α2b before infection renders both cell lines resistant to EV30 and EV71, whereas post-infection treatment with IFN-α2b rescues viral susceptibility fully only in MDA5-deficient fibroblasts. Finally, the poly(I:C) and viral phenotypes of fibroblasts are rescued by the expression of WT TLR3 or MDA5. Human TLR3 and MDA5 are critical for cell-intrinsic immunity to EV, via the control of baseline and virus-induced type I IFN production, respectively.
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