Human Mannose-binding Lectin in Immunity: Friend, Foe, or Both?

Human mannose-binding lectin (MBL) recognizes a wide range of microorganisms and triggers the most ancient pathway of complement activation. However, ∼5% of individuals lack functional serum MBL and have not been found to be prone to severe infections in prospective studies. These data suggest that human MBL is largely redundant for protective immunity and may even have been subject to counter selection because of a deleterious impact

Inborn errors of immunity to infection: the rule rather than the exception

The immune system's function is to protect against microorganisms, but infection is nonetheless the most frequent cause of death in human history. Until the last century, life expectancy was only ∼25 years. Recent increases in human life span primarily reflect the development of hygiene, vaccines, and anti-infectious drugs, rather than the adjustment of our immune system to coevolving microbes by natural selection. We argue here that most individuals retain a natural vulnerability to infectious diseases, reflecting a great diversity of inborn errors of immunity

Human life within a narrow range: the lethal ups and downs of type I interferons

The past 20 years have seen the definition of human monogenic disorders and their autoimmune phenocopies underlying either defective or enhanced type I interferon (IFN) activity. These disorders delineate the impact of type I IFNs in natural conditions and demonstrate that only a narrow window of type I IFN activity is beneficial. Insufficient type I IFN predisposes humans to life-threatening viral diseases (albeit unexpectedly few) with a central role in immunity to respiratory and cerebral viral infection. Excessive type I IFN, perhaps counterintuitively, appears to underlie a greater number of autoinflammatory and/or autoimmune conditions known as type I interferonopathies, whose study has revealed multiple molecular programs involved in the induction of type I IFN signaling. These observations suggest that the manipulation of type I IFN activity to within a physiological range may be clinically relevant for the prevention and treatment of viral and inflammatory diseases

The Genetic Dissection of Isolated Congenital Asplenia in Humans

L asplénie ou l absence de la rate peut être congénitale, c est- à -dire absente dès la naissance, ou bien acquise, par exemple lors d une opération après un accident. L asplénie congénitale est le plus souvent associée à d autres problèmes développementaux. En particulier l asplénie congénitale est associée à des problèmes de développement du cœur, dans le cadre des syndromes d hétérotaxie. Ces syndromes d hétérotaxie sont caractérisés par des problèmes de latéralité droite-gauche. Ainsi une personne ayant deux parties droites n aura pas de rate. A contrario, l asplénie congénitale isolée est caractérisée par l absence de rate et aucune autre malformation. L asplénie congénitale isolée est une maladie très rare. Nous avons estimé la fréquence de la maladie à un cas pour un million de naissances. C est aussi une maladie extrêmement mortelle. La grande majorité des patients ayant une asplénie congénitale isolée souffrent d infections bactériennes sévères lors de l enfance et la moitie des cas reportés sont décédés dus à une infection bactérienne, le plus souvent du à une infection par Streptococcus pneumoniae. Malgré la sévérité de cette maladie, celle-ci reste très peu connue et très peu étudiée. Ainsi le diagnostique est souvent trop tardif. Parmi les quelques dizaines de cas décrits dans la littérature, la moitié sont des cas familiaux avec plusieurs membres de la même famille affectée. Le mode de transmission semble être autosomique dominant dans la majorité des cas. En outre aucune preuve n existe concernant un facteur environnemental pour cette maladie. Enfin des travaux récents ont montrés que l absence de pancréas chez l homme était une maladie génétique, et due à des mutations dans le gène GATA6 chez la moitié des patients. L objectif de cette thèse est donc de déterminer l origine génétique de l asplénie congénitale isolée chez l homme. J ai fait l hypothèse que l asplénie congénitale isolée chez l homme est due à des mutations mendéliennes dans un gène important pour le développement de la rate. Afin de tester notre hypothèse nous avons recruté des patients à travers des collaborations avec des médecins étrangers ainsi qu un partenariat avec toutes les unités pédiatriques de France. Nous avons finalement pu recruter 37 patients appartenant à 24 familles différentes. La littérature sur le développement de la rate chez la souris et encore plus sur l homme étant minimale, il était difficile d identifier de bons gènes candidats pour être responsables de l asplénie. Nous avons donc opté pour une stratégie portant sur le génome entier, sans biais lier a la littérature. La stratégie était d utiliser le séquençage de l exome de tous les patients. Le séquençage de l exome est en fait le séquençage de tous les exons du génome, ou au moins 90% des exons du génome. La technique du séquençage de l exome est arrivée à la fin de l année 2009 et nous avons été un des premiers laboratoires à l utiliser. Il fallait donc que nous l essayons en premier sur un cas facile afin de vérifier que cette technique fonctionnait. Nous avons donc fait une étude préliminaire sur un cas facile . Par cas facile, il faut comprendre un cas où la probabilité que ce soit une mutation mendélienne dans un gène qui soit responsable de la maladie soit la plus forte possible, et où le nombre de gènes à regarder soit le plus faible possible. Un cas facile est donc le cas d une famille avec de nombreux patients, et de surcroit une famille consanguine. Dans le cas d une famille consanguine la probabilité que ce soit une mutation récessive qui soit responsable de la maladie génétique est très importante. On peut alors se restreindre à analyser les régions du génome ou toutes les variations sont homozygotes. Nous avions une famille dans ce cas. Il y avait 4 patients dans cette famille souffrant d infections bactériennes sévères dues à une asplenie fonctionnelle, ainsi que d infections viralesIsolated congenital asplenia (ICA) is a rare primary immunodeficiency, first described in 1956, thattypically manifests in childhood with sudden, life-threatening, invasive bacterial disease. Patients withICA do not display any other overt developmental anomalies. The genetic etiology of ICA has remainedelusive. I hypothesized that ICA results from single-gene inborn errors of spleen development. I aimedto decipher the molecular genetic basis of ICA by pursuing a genome-wide approach, based on thesequencing of the whole-exome and the detection of copy number variations in all patients of ourcohort. I found that heterozygous mutations in RPSA, ribosomal protein SA, were present in more thanhalf of ICA patients (19/33). I then showed that haploinsufficiency of RPSA led to ICA in one kindredat least. RPSA is a protein involved in pre-rRNA processing and is an integral part of the ribosome. Thechallenge is, now, to understand the pathogenesis of the disease. How does a mutation in a ubiquitousand highly expressed gene lead to a spleen specific phenotype? This discovery will set the basis for abroader understanding of the development of the spleen in humans and the function of a ribosomalprotein. This discovery will also be beneficial to the families of patients with ICA, guiding geneticcounseling. It will lead to prevention of infections in newborns with mutations in RPSA. Finally themethod we used to analyze the exomes of the ICA cohort will be useful to discover the genetic etiologyof other genetic diseases.PARIS5-Bibliotheque electronique (751069902) / SudocSudocFranceF

IFN-gamma mediates the rejection of haematopoietic stem cells in IFN-gammaR1-deficient hosts.

International audienceBACKGROUND: Interferon-gamma receptor 1 (IFN-gammaR1) deficiency is a life-threatening inherited disorder, conferring predisposition to mycobacterial diseases. Haematopoietic stem cell transplantation (HSCT) is the only curative treatment available, but is hampered by a very high rate of graft rejection, even with intra-familial HLA-identical transplants. This high rejection rate is not seen in any other congenital disorders and remains unexplained. We studied the underlying mechanism in a mouse model of HSCT for IFN-gammaR1 deficiency. METHODS AND FINDINGS: We demonstrated that HSCT with cells from a syngenic C57BL/6 Ifngr1+/+ donor engrafted well and restored anti-mycobacterial immunity in naive, non-infected C57BL/6 Ifngr1-/- recipients. However, Ifngr1-/- mice previously infected with Mycobacterium bovis bacillus Calmette-Guérin (BCG) rejected HSCT. Like infected IFN-gammaR1-deficient humans, infected Ifngr1-/- mice displayed very high serum IFN-gamma levels before HSCT. The administration of a recombinant IFN-gamma-expressing AAV vector to Ifngr1-/- naive recipients also resulted in HSCT graft rejection. Transplantation was successful in Ifngr1-/- x Ifng-/- double-mutant mice, even after BCG infection. Finally, efficient antibody-mediated IFN-gamma depletion in infected Ifngr1-/- mice in vivo allowed subsequent engraftment. CONCLUSIONS: High serum IFN-gamma concentration is both necessary and sufficient for graft rejection in IFN-gammaR1-deficient mice, inhibiting the development of heterologous, IFN-gammaR1-expressing, haematopoietic cell lineages. These results confirm that IFN-gamma is an anti-haematopoietic cytokine in vivo. They also pave the way for HSCT management in IFN-gammaR1-deficient patients through IFN-gamma depletion from the blood. They further raise the possibility that depleting IFN-gamma may improve engraftment in other settings, such as HSCT from a haplo-identical or unrelated donor

A Comparative Analysis of the Endocannabinoid System in the Retina of Mice, Tree Shrews, and Monkeys

The endocannabinoid (eCB) system is widely expressed in various parts of the central nervous system, including the retina. The localization of the key eCB receptors, particularly CB1R and CB2R, has been recently reported in rodent and primate retinas with striking interspecies differences. Little is known about the distribution of the enzymes involved in the synthesis and degradation of these eCBs. We therefore examined the expression and localization of the main components of the eCB system in the retina of mice, tree shrews, and monkeys. We found that CB1R and FAAH distributions are well-preserved among these species. However, expression of NAPE-PLD is circumscribed to the photoreceptor layer only in monkeys. In contrast, CB2R expression is variable across these species; in mice, CB2R is found in retinal neurons but not in glial cells; in tree shrews, CB2R is expressed in Müller cell processes of the outer retina and in retinal neurons of the inner retina; in monkeys, CB2R is restricted to Müller cells. Finally, the expression patterns of MAGL and DAGLα are differently expressed across species. Overall, these results provide evidence that the eCB system is differently expressed in the retina of these mammals and suggest a distinctive role of eCBs in visual processing

Inherited DOCK2 Deficiency in Patients with Early-Onset Invasive Infections

Background Combined immunodeficiencies are marked by inborn errors of T-cell immunity in which the T cells that are present are quantitatively or functionally deficient. Impaired humoral immunity is also common. Patients have severe infections, autoimmunity, or both. The specific molecular, cellular, and clinical features of many types of combined immunodeficiencies remain unknown. Methods We performed genetic and cellular immunologic studies involving five unrelated children with early-onset invasive bacterial and viral infections, lymphopenia, and defective T-cell, B-cell, and natural killer (NK)-cell responses. Two patients died early in childhood; after allogeneic hematopoietic stem-cell transplantation, the other three had normalization of T-cell function and clinical improvement. Results We identified biallelic mutations in the dedicator of cytokinesis 2 gene (DOCK2) in these five patients. RAC1 activation was impaired in the T cells. Chemokine-induced migration and actin polymerization were defective in the T cells, B cells, and NK cells. NK-cell degranulation was also affected. Interferon-alpha and interferon-lambda production by peripheral-blood mononuclear cells was diminished after viral infection. Moreover, in DOCK2-deficient fibroblasts, viral replication was increased and virus-induced cell death was enhanced; these conditions were normalized by treatment with interferon alfa-2b or after expression of wild-type DOCK2. Conclusions Autosomal recessive DOCK2 deficiency is a new mendelian disorder with pleiotropic defects of hematopoietic and nonhematopoietic immunity. Children with clinical features of combined immunodeficiencies, especially with early-onset, invasive infections, may have this condition. (Supported by the National Institutes of Health and others.)

Vaccine breakthrough hypoxemic COVID-19 pneumonia in patients with auto-Abs neutralizing type I IFNs

Life-threatening 'breakthrough' cases of critical COVID-19 are attributed to poor or waning antibody response to the SARS-CoV-2 vaccine in individuals already at risk. Pre-existing autoantibodies (auto-Abs) neutralizing type I IFNs underlie at least 15% of critical COVID-19 pneumonia cases in unvaccinated individuals; however, their contribution to hypoxemic breakthrough cases in vaccinated people remains unknown. Here, we studied a cohort of 48 individuals (age 20-86 years) who received 2 doses of an mRNA vaccine and developed a breakthrough infection with hypoxemic COVID-19 pneumonia 2 weeks to 4 months later. Antibody levels to the vaccine, neutralization of the virus, and auto-Abs to type I IFNs were measured in the plasma. Forty-two individuals had no known deficiency of B cell immunity and a normal antibody response to the vaccine. Among them, ten (24%) had auto-Abs neutralizing type I IFNs (aged 43-86 years). Eight of these ten patients had auto-Abs neutralizing both IFN-α2 and IFN-ω, while two neutralized IFN-ω only. No patient neutralized IFN-β. Seven neutralized 10 ng/mL of type I IFNs, and three 100 pg/mL only. Seven patients neutralized SARS-CoV-2 D614G and the Delta variant (B.1.617.2) efficiently, while one patient neutralized Delta slightly less efficiently. Two of the three patients neutralizing only 100 pg/mL of type I IFNs neutralized both D61G and Delta less efficiently. Despite two mRNA vaccine inoculations and the presence of circulating antibodies capable of neutralizing SARS-CoV-2, auto-Abs neutralizing type I IFNs may underlie a significant proportion of hypoxemic COVID-19 pneumonia cases, highlighting the importance of this particularly vulnerable population