Loss of the interleukin-6 receptor causes immunodeficiency, atopy, and abnormal inflammatory responses

Author:

Spencer Sarah12ORCID,Köstel Bal Sevgi34ORCID,Egner William56,Lango Allen Hana78ORCID,Raza Syed I.9,Ma Chi A.10,Gürel Meltem11,Zhang Yuan10ORCID,Sun Guangping10,Sabroe Ruth A.12,Greene Daniel7813,Rae William2,Shahin Tala34,Kania Katarzyna11ORCID,Ardy Rico Chandra34ORCID,Thian Marini341415ORCID,Staples Emily2,Pecchia-Bekkum Annika2,Worrall William P.M.2ORCID,Stephens Jonathan7816,Brown Matthew7816,Tuna Salih7816,York Melanie56ORCID,Shackley Fiona56,Kerrin Diarmuid17,Sargur Ravishankar56ORCID,Condliffe Alison56ORCID,Tipu Hamid Nawaz18ORCID,Kuehn Hye Sun19,Rosenzweig Sergio D.19,Turro Ernest781316ORCID,Tavaré Simon112021ORCID,Thrasher Adrian J.22ORCID,Jodrell Duncan Ian23ORCID,Smith Kenneth G.C.2ORCID,Boztug Kaan34141524ORCID,Milner Joshua D.10ORCID,Thaventhiran James E.D.1211ORCID

Affiliation:

1. Medical Research Council Toxicology Unit, University of Cambridge, Cambridge, UK

2. Department of Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK

3. Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria

4. CeMM Research Center for Molecular Medicine, Austrian Academy of Sciences, Vienna, Austria

5. Sheffield Teaching Hospitals National Health Service Trust, Sheffield, UK

6. Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK

7. Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK

8. National Institute for Health Research BioResource, Cambridge University Hospitals, Cambridge Biomedical Campus, Cambridge, UK

9. Department of Biochemistry, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan

10. Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD

11. Cancer Research UK Cambridge Institute, Cambridge Biomedical Campus, Cambridge, UK

12. Department of Dermatology, Sheffield Teaching Hospitals National Health Service Trust, Sheffield, UK

13. Medical Research Council Biostatistics Unit, Cambridge Biomedical Campus, Cambridge, UK

14. Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria

15. St. Anna Kinderspital and Children’s Cancer Research Institute, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria

16. National Health Service Blood and Transplant Cambridge, Cambridge Biomedical Campus, Cambridge, UK

17. Barnsley Hospitals National Health Service Foundation Trust, Barnsley, UK

18. Immunology Department, Armed Forces Institute of Pathology, Rawalpindi, Pakistan

19. Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD

20. Herbert and Florence Irving Institute for Cancer Dynamics, Columbia University, New York, NY

21. New York Genome Center, New York, NY

22. Molecular and Cellular Immunology Section, University College London Great Ormond Street Institute of Child Health, Great Ormond Street Hospital National Health Service Trust, London, UK

23. Department of Oncology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK

24. Vienna Center for Rare and Undiagnosed Diseases, Vienna, Austria

Abstract

IL-6 excess is central to the pathogenesis of multiple inflammatory conditions and is targeted in clinical practice by immunotherapy that blocks the IL-6 receptor encoded by IL6R. We describe two patients with homozygous mutations in IL6R who presented with recurrent infections, abnormal acute-phase responses, elevated IgE, eczema, and eosinophilia. This study identifies a novel primary immunodeficiency, clarifying the contribution of IL-6 to the phenotype of patients with mutations in IL6ST, STAT3, and ZNF341, genes encoding different components of the IL-6 signaling pathway, and alerts us to the potential toxicity of drugs targeting the IL-6R.

Funder

Medical Research Council

European Research Council

Austrian Science Fund

National Institute of Allergy and Infectious Diseases

NIH

Wellcome Trust

NIHR

University College London

Wellcome

Cancer Research UK

Austrian Academy of Sciences

British Heart Foundation

NHS England

Publisher

Rockefeller University Press

Subject

Immunology,Immunology and Allergy

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