Multisystem inflammatory syndrome in children (MIS-C) is a rare and severe condition that follows benign COVID-19. We report autosomal recessive deficiencies of OAS1, OAS2, or RNASEL in five unrelated children with MIS-C. The cytosolic double-stranded RNA (dsRNA)-sensing OAS1 and OAS2 generate 2'-5'-linked oligoadenylates (2-5A) that activate the single-stranded RNA-degrading ribonuclease L (RNase L). Monocytic cell lines and primary myeloid cells with OAS1, OAS2, or RNase L deficiencies produce excessive amounts of inflammatory cytokines upon dsRNA or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) stimulation. Exogenous 2-5A suppresses cytokine production in OAS1-deficient but not RNase L-deficient cells. Cytokine production in RNase L-deficient cells is impaired by MDA5 or RIG-I deficiency and abolished by mitochondrial antiviral-signaling protein (MAVS) deficiency. Recessive OAS-RNase L deficiencies in these patients unleash the production of SARS-CoV-2-triggered, MAVS-mediated inflammatory cytokines by mononuclear phagocytes, thereby underlying MIS-C.

Inborn errors of OAS-RNase L in SARS-CoV-2-related multisystem inflammatory syndrome in children / Lee, D.; Le Pen, J.; Yatim, A.; Dong, B.; Aquino, Y.; Ogishi, M.; Pescarmona, R.; Talouarn, E.; Rinchai, D.; Zhang, P.; Perret, M.; Liu, Z.; Jordan, I.; Bozdemir, S. E.; Bayhan, G. I.; Beaufils, C.; Bizien, L.; Bisiaux, A.; Lei, W.; Hasan, M.; Chen, J.; Gaughan, C.; Asthana, A.; Libri, V.; Luna, J. M.; Jaffre, F.; Hoffmann, H. -H.; Michailidis, E.; Moreews, M.; Seeleuthner, Y.; Bilguvar, K.; Mane, S.; Flores, C.; Zhang, Y.; Arias, A. A.; Bailey, R.; Schluter, A.; Milisavljevic, B.; Bigio, B.; Le Voyer, T.; Materna, M.; Gervais, A.; Moncada-Velez, M.; Pala, F.; Lazarov, T.; Levy, R.; Neehus, A. -L.; Rosain, J.; Peel, J.; Chan, Y. -H.; Morin, M. -P.; Pino-Ramirez, R. M.; Belkaya, S.; Lorenzo, L.; Anton, J.; Delafontaine, S.; Toubiana, J.; Bajolle, F.; Fumado, V.; Dediego, M. L.; Fidouh, N.; Rozenberg, F.; Perez-Tur, J.; Chen, S.; Evans, T.; Geissmann, F.; Lebon, P.; Weiss, S. R.; Bonnet, D.; Duval, X.; Pan-Hammarstrom, Q.; Planas, A. M.; Meyts, I.; Haerynck, F.; Pujol, A.; Sancho-Shimizu, V.; Dalgard, C. L.; Bustamante, J.; Puel, A.; Boisson-Dupuis, S.; Boisson, B.; Maniatis, T.; Zhang, Q.; Bastard, P.; Notarangelo, L.; Beziat, V.; de Diego, R. P.; Rodriguez-Gallego, C.; Su, H. C.; Lifton, R. P.; Jouanguy, E.; Cobat, A.; Alsina, L.; Keles, S.; Haddad, E.; Abel, L.; Belot, A.; Quintana-Murci, L.; Rice, C. M.; Silverman, R. H.; Zhang, S. -Y.; Casanova, J. -L.; Alavoine, L.; Behillil, S.; Burdet, C.; Charpentier, C.; Dechanet, A.; Descamps, D.; Ecobichon, J. -L.; Enouf, V.; Frezouls, W.; Houhou, N.; Kafif, O.; Lehacaut, J.; Letrou, S.; Lina, B.; Lucet, J. -C.; Manchon, P.; Nouroudine, M.; Piquard, V.; Quintin, C.; Thy, M.; Tubiana, S.; van der Werf, S.; Vignali, V.; Visseaux, B.; Yazdanpanah, Y.; Chahine, A.; Waucquier, N.; Migaud, M. -C.; Deplanque, D.; Djossou, F.; Mergeay-Fabre, M.; Lucarelli, A.; Demar, M.; Bruneau, L.; Gerardin, P.; Maillot, A.; Payet, C.; Laviolle, B.; Laine, F.; Paris, C.; Desille-Dugast, M.; Fouchard, J.; Malvy, D.; Nguyen, D.; Pistone, T.; Perreau, P.; Gissot, V.; Le Goas, C.; Montagne, S.; Richard, L.; Chirouze, C.; Bouiller, K.; Desmarets, M.; Meunier, A.; Lefevre, B.; Jeulin, H.; Legrand, K.; Lomazzi, S.; Tardy, B.; Gagneux-Brunon, A.; Bertholon, F.; Botelho-Nevers, E.; Christelle, K.; Nicolas, L.; Roufai, L.; Amat, K.; Couffin-Cadiergues, S.; Esperou, H.; Hendou, S.; Abolhassani, H.; Aguilera-Albesa, S.; Aiuti, A.; Akcan, O. M.; Akcay, N.; Alkan, G.; Alkhater, S. A.; Allende, L. M.; Alper, Y.; Amenzoui, N.; Anderson, M. S.; Arkin, L.; Aubart, M.; Avramenko, I.; Aydemir, S.; Aydin, Z. G. G.; Aytekin, C.; Aytekin, G.; Aytekin, S. E.; Bando, S. Y.; Beland, K.; Biggs, C. M.; Aburto, A. B.; Blanchard-Rohner, G.; Blazquez-Gamero, D.; Bloomfield, M.; Bogunovic, D.; Bondarenko, A.; Borghesi, A.; Bousfiha, A. A.; Boyarchuk, O.; Brodin, P.; Bryceson, Y.; Bucciol, G.; Calcaterra, V.; Casari, G.; Cavalcanti, A.; Celik, J. B.; Chrousos, G. P.; Colobran, R.; Condino-Neto, A.; Conti, F.; Cooper, M.; Coskuner, T.; Cyrus, C.; D'Auria, E.; Drolet, B. A.; Duramaz, B. B.; El Zein, L.; Elnagdy, M. H.; Emiroglu, M.; Erdeniz, E. H.; Fabi, M.; Feldman, H. B.; Fellay, J.; Fencl, F.; Filippatos, F.; Freiss, J.; Fremuth, J.; Gagro, A.; Garcia-Solis, B.; Vergine, G.; Gonzalez-Montelongo, R.; Gul, Y.; Gulhan, B.; Gultekin, S. S. K.; Gut, M.; Halwani, R.; Hammarstrom, L.; Hatipoglu, N.; Heath, J.; Henrickson, S. E.; Hernandez-Brito, E.; Hoffman, I.; Hoste, L.; Hsieh, E.; Inigo-Campos, A.; Itan, Y.; Jabandziev, P.; Kandemir, B.; Kanik-Yuksek, S.; Kapakli, H.; Karbuz, A.; Kasapcopur, O.; Kechiche, R.; Demirkol, Y. K.; Kilic, O.; Hansen, S. K.; Klocperk, A.; Lau, Y. -L.; Lebl, J.; Lorenzo-Salazar, J. M.; Lucas, C. L.; Maglorius, M.; Marque, L.; Medina, Y. N.; Melian, A. M.; Mentis, A. -F. A.; Pato, M. T.; Michos, A.; Milner, J. D.; Mogensen, T. H.; Munoz-Barrera, A.; Nepesov, S.; Neves, J. F.; Ng, A.; Ng, L. F. P.; Novelli, A.; Novelli, G.; Oz, F. N.; Ocejo-Vinals, J. G.; Okada, S.; Orbak, Z.; Kilic, A. O.; Ouair, H.; Oz, S. K. T.; Ozcelik, T.; Ozkan, E. A.; Parlakay, A. O.; Pato, C. N.; Paz-Artal, E.; Pelham, S.; Pellier, I.; Philippot, Q.; Planas-Serra, L.; Plassart, S.; Pokorna, P.; Polat, M.; Poli, C.; Prando, C.; Renia, L.; Riviere, J. G.; Rodriguez-Palmero, A.; Roussel, L.; Rubio-Rodriguez, L. A.; Salifu, M.; Sasek, L.; Sasia, L.; Scherbina, A.; Schmitt, E.; Sediva, A.; Sevketoglu, E.; Slaba, K.; Slaby, O.; Sobh, A.; Sole-Violan, J.; Soler-Palacin, P.; De Somer, L.; Sozeri, B.; Spaan, A. N.; Stepanovskiy, Y.; Tangye, S. G.; Tanir, G.; Tatsi, E. -B.; Thorball, C. W.; Torun, S. H.; Turvey, S.; Tayoun, A. A.; Ramaswamy, S.; Uddin, M. J.; Uyar, E.; Valencia-Ramos, J.; Van Den Rym, A. M.; Vatansev, H.; de Vera, M. C.; Vermeulen, F.; Vinh, D. C.; Volokha, A.; von Bernuth, H.; Wouters, C.; Yahsi, A.; Yarar, V.; Yesilbas, O.; Yildiz, M.; Zatz, M.; Zawadzki, P.; Zuccotti, G.. - In: SCIENCE. - ISSN 0036-8075. - 379:6632(2023). [10.1126/science.abo3627]

Inborn errors of OAS-RNase L in SARS-CoV-2-related multisystem inflammatory syndrome in children

Aiuti A.
Membro del Collaboration Group
;
Casari G.
Membro del Collaboration Group
;
2023-01-01

Abstract

Multisystem inflammatory syndrome in children (MIS-C) is a rare and severe condition that follows benign COVID-19. We report autosomal recessive deficiencies of OAS1, OAS2, or RNASEL in five unrelated children with MIS-C. The cytosolic double-stranded RNA (dsRNA)-sensing OAS1 and OAS2 generate 2'-5'-linked oligoadenylates (2-5A) that activate the single-stranded RNA-degrading ribonuclease L (RNase L). Monocytic cell lines and primary myeloid cells with OAS1, OAS2, or RNase L deficiencies produce excessive amounts of inflammatory cytokines upon dsRNA or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) stimulation. Exogenous 2-5A suppresses cytokine production in OAS1-deficient but not RNase L-deficient cells. Cytokine production in RNase L-deficient cells is impaired by MDA5 or RIG-I deficiency and abolished by mitochondrial antiviral-signaling protein (MAVS) deficiency. Recessive OAS-RNase L deficiencies in these patients unleash the production of SARS-CoV-2-triggered, MAVS-mediated inflammatory cytokines by mononuclear phagocytes, thereby underlying MIS-C.
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