Human inborn errors of immunity to infection affecting cells other than leukocytes: from the immune system to the whole organism

Curr Opin Immunol. 2019 Aug;59:88-100. doi: 10.1016/j.coi.2019.03.008. Epub 2019 May 20.


Studies of vertebrate immunity have traditionally focused on professional cells, including circulating and tissue-resident leukocytes. Evidence that non-professional cells are also intrinsically essential (i.e. not via their effect on leukocytes) for protective immunity in natural conditions of infection has emerged from three lines of research in human genetics. First, studies of Mendelian resistance to infection have revealed an essential role of DARC-expressing erythrocytes in protection against Plasmodium vivax infection, and an essential role of FUT2-expressing intestinal epithelial cells for protection against norovirus and rotavirus infections. Second, studies of inborn errors of non-hematopoietic cell-extrinsic immunity have shown that APOL1 and complement cascade components secreted by hepatocytes are essential for protective immunity to trypanosome and pyogenic bacteria, respectively. Third, studies of inborn errors of non-hematopoietic cell-intrinsic immunity have suggested that keratinocytes, pulmonary epithelial cells, and cortical neurons are essential for tissue-specific protective immunity to human papillomaviruses, influenza virus, and herpes simplex virus, respectively. Various other types of genetic resistance or predisposition to infection in human populations are not readily explained by inborn variants of genes operating in leukocytes and may, therefore, involve defects in other cells. The probing of this unchartered territory by human genetics is reshaping immunology, by scaling immunity to infection up from the immune system to the whole organism.

Publication types

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

MeSH terms

  • Animals
  • Apolipoprotein L1 / metabolism
  • Complement System Proteins / metabolism
  • Duffy Blood-Group System / metabolism
  • Epithelial Cells / immunology*
  • Erythrocytes / immunology*
  • Fucosyltransferases / metabolism
  • Hepatocytes / immunology*
  • Humans
  • Immune System
  • Immune System Diseases / immunology*
  • Infant, Newborn
  • Infant, Newborn, Diseases / immunology*
  • Infections / immunology*
  • Leukocytes / immunology
  • Receptors, Cell Surface / metabolism


  • ACKR1 protein, human
  • Apolipoprotein L1
  • Duffy Blood-Group System
  • Receptors, Cell Surface
  • Complement System Proteins
  • Fucosyltransferases
  • galactoside 2-alpha-L-fucosyltransferase