Human Adaptive Immunity Rescues an Inborn Error of Innate Immunity

Cell. 2017 Feb 23;168(5):789-800.e10. doi: 10.1016/j.cell.2017.01.039.

Abstract

The molecular basis of the incomplete penetrance of monogenic disorders is unclear. We describe here eight related individuals with autosomal recessive TIRAP deficiency. Life-threatening staphylococcal disease occurred during childhood in the proband, but not in the other seven homozygotes. Responses to all Toll-like receptor 1/2 (TLR1/2), TLR2/6, and TLR4 agonists were impaired in the fibroblasts and leukocytes of all TIRAP-deficient individuals. However, the whole-blood response to the TLR2/6 agonist staphylococcal lipoteichoic acid (LTA) was abolished only in the index case individual, the only family member lacking LTA-specific antibodies (Abs). This defective response was reversed in the patient, but not in interleukin-1 receptor-associated kinase 4 (IRAK-4)-deficient individuals, by anti-LTA monoclonal antibody (mAb). Anti-LTA mAb also rescued the macrophage response in mice lacking TIRAP, but not TLR2 or MyD88. Thus, acquired anti-LTA Abs rescue TLR2-dependent immunity to staphylococcal LTA in individuals with inherited TIRAP deficiency, accounting for incomplete penetrance. Combined TIRAP and anti-LTA Ab deficiencies underlie staphylococcal disease in this patient.

Keywords: LTA; TIRAP; anti-LTA antibodies; incomplete clinical penetrance; lipoteichoic acid; primary immunodeficiency; staphylococcus aureus; toll-like receptors.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adaptive Immunity
  • Antibodies, Monoclonal / administration & dosage*
  • Child
  • Female
  • Fibroblasts / metabolism
  • Humans
  • Immunity, Innate
  • Lipopolysaccharides / immunology
  • Lipopolysaccharides / metabolism*
  • Macrophages / immunology
  • Male
  • Membrane Glycoproteins / analysis
  • Membrane Glycoproteins / deficiency*
  • Membrane Glycoproteins / genetics
  • Monocytes / metabolism
  • Myeloid Differentiation Factor 88 / metabolism
  • Pedigree
  • Phagocytes / metabolism
  • Point Mutation
  • Protein Isoforms / analysis
  • Protein Isoforms / genetics
  • Receptors, Interleukin-1 / analysis
  • Receptors, Interleukin-1 / deficiency*
  • Receptors, Interleukin-1 / genetics
  • Staphylococcal Infections / drug therapy
  • Staphylococcal Infections / genetics*
  • Staphylococcal Infections / immunology*
  • Teichoic Acids / immunology
  • Teichoic Acids / metabolism*
  • Toll-Like Receptor 2 / metabolism
  • Toll-Like Receptors / agonists
  • Toll-Like Receptors / metabolism

Substances

  • Antibodies, Monoclonal
  • Lipopolysaccharides
  • MYD88 protein, human
  • Membrane Glycoproteins
  • Myeloid Differentiation Factor 88
  • Protein Isoforms
  • Receptors, Interleukin-1
  • TIRAP protein, human
  • TLR2 protein, human
  • Teichoic Acids
  • Toll-Like Receptor 2
  • Toll-Like Receptors
  • lipoteichoic acid