Inherited IFNAR1 deficiency in otherwise healthy patients with adverse reaction to measles and yellow fever live vaccines

Author:

Hernandez Nicholas1,Bucciol Giorgia2ORCID,Moens Leen2,Le Pen Jérémie3,Shahrooei Mohammad45ORCID,Goudouris Ekaterini6ORCID,Shirkani Afshin7ORCID,Changi-Ashtiani Majid8,Rokni-Zadeh Hassan9,Sayar Esra Hazar10ORCID,Reisli Ismail10,Lefevre-Utile Alain11ORCID,Zijlmans Dick3,Jurado Andrea3,Pholien Ruben12ORCID,Drutman Scott1ORCID,Belkaya Serkan1ORCID,Cobat Aurelie13ORCID,Boudewijns Robbert12ORCID,Jochmans Dirk12ORCID,Neyts Johan12ORCID,Seeleuthner Yoann1415,Lorenzo-Diaz Lazaro1415,Enemchukwu Chibuzo3,Tietjen Ian3,Hoffmann Hans-Heinrich3ORCID,Momenilandi Mana4,Pöyhönen Laura1,Siqueira Marilda M.16,de Lima Sheila M. Barbosa17,de Souza Matos Denise C.18,Homma Akira19,Maia Maria de Lourdes S.19,da Costa Barros Tamiris Azamor18,de Oliveira Patricia Mouta Nunes19,Mesquita Emersom Ciclini19,Gijsbers Rik2021,Zhang Shen-Ying11415ORCID,Seligman Stephen J.122ORCID,Abel Laurent11415ORCID,Hertzog Paul23,Marr Nico2425ORCID,Martins Reinaldo de Menezes19,Meyts Isabelle22627,Zhang Qian1,MacDonald Margaret R.3ORCID,Rice Charles M.3,Casanova Jean-Laurent113141528ORCID,Jouanguy Emmanuelle11415ORCID,Bossuyt Xavier2930

Affiliation:

1. St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY

2. Laboratory of Inborn Errors of Immunity, Department of Immunology, Microbiology and Transplantation, KU Leuven, Leuven, Belgium

3. Laboratory of Virology and Infectious Disease, The Rockefeller University, New York, NY

4. Specialized Immunology Laboratory of Dr. Shahrooei, Sina Medical Complex, Ahvaz, Iran

5. Department of Microbiology and Immunology, Clinical and Diagnostic Immunology, KU Leuven, Leuven, Belgium

6. Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

7. Allergy and Clinical Immunology Department, Bushehr University of Medical Science, School of Medicine, Bushehr, Iran

8. School of Mathematics, Institute for Research in Fundamental Sciences, Tehran, Iran

9. Department of Medical Biotechnology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran

10. Department of Pediatrics, Division of Pediatric Immunology and Allergy, Necmettin Erbakan University, Meram Medical Faculty, Konya, Turkey

11. Pediatrics Department, Jean Verdier Hospital, Assistance Publique des Hôpitaux de Paris, Paris 13 University, Bondy, France

12. Laboratory of Virology and Chemotherapy, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium

13. Pediatric Immunology-Hematology Unit, Assistance Publique-Hôpitaux de Paris, Necker Hospital for Sick Children, Paris, France

14. Paris Descartes University, Imagine Institute, Paris, France

15. Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale U1163, Paris, France

16. National Reference Laboratory for Respiratory Viruses, Institute Oswaldo Cruz, Fiocruz, Ministry of Health, Rio de Janeiro, Brazil

17. Laboratory of Virological Techniques, Bio-Manguinhos, Fiocruz, Ministry of Health, Rio de Janeiro, Brazil

18. Laboratory of Immunological Techniques, Bio-Manguinhos, Fiocruz, Ministry of Health, Rio de Janeiro, Brazil

19. Bio-Manguinhos, Fiocruz, Ministry of Health, Rio de Janeiro, Brazil

20. Laboratory for Viral Vector Technology and Gene Therapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium

21. Leuven Viral Vector Core, Leuven, Belgium

22. Department of Microbiology and Immunology, New York Medical College, Valhalla, NY

23. Hudson Institute of Medical Research, Clayton, Victoria, Australia

24. Division of Translational Medicine, Sidra Medicine, Doha, Qatar

25. College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar

26. Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium

27. Precision Immunology Institute and Mindich Child Health and Development Institute at the Icahn School of Medicine at Mount Sinai, New York, NY

28. Howard Hughes Medical Institute, New York, NY

29. Department of Microbiology, Immunology and Transplantation, Clinical and Diagnostic Immunology, KU Leuven, Leuven, Belgium

30. Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium

Abstract

Vaccination against measles, mumps, and rubella (MMR) and yellow fever (YF) with live attenuated viruses can rarely cause life-threatening disease. Severe illness by MMR vaccines can be caused by inborn errors of type I and/or III interferon (IFN) immunity (mutations in IFNAR2, STAT1, or STAT2). Adverse reactions to the YF vaccine have remained unexplained. We report two otherwise healthy patients, a 9-yr-old boy in Iran with severe measles vaccine disease at 1 yr and a 14-yr-old girl in Brazil with viscerotropic disease caused by the YF vaccine at 12 yr. The Iranian patient is homozygous and the Brazilian patient compound heterozygous for loss-of-function IFNAR1 variations. Patient-derived fibroblasts are susceptible to viruses, including the YF and measles virus vaccine strains, in the absence or presence of exogenous type I IFN. The patients’ fibroblast phenotypes are rescued with WT IFNAR1. Autosomal recessive, complete IFNAR1 deficiency can result in life-threatening complications of vaccination with live attenuated measles and YF viruses in previously healthy individuals.

Funder

National Center for Research Resources

National Center for Advancing Translational Sciences

National Institute of Allergy and Infectious Diseases

US Department of Health and Human Services

St. Giles Foundation

Agence Nationale de la Recherche

Laboratoire d’Excellence Integrative Biology of Emerging Infectious Diseases

Institut National de la Santé et de la Recherche Médicale

National Immunization Program

Institute of Technology in Immunobiology

Ministry of Health

KU Leuven

Caps-It

Hercules Foundation

Rega Foundation

Fonds Wetenschappelijk Onderzoek

Université Paris Descartes

National Institute of General Medical Sciences

National Institutes of Health

Francois Wallace Monahan

European Molecular Biology Organization

Publisher

Rockefeller University Press

Subject

Immunology,Immunology and Allergy

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