Tuberculosis in otherwise healthy adults with inherited TNF deficiency
Andrés A. Arias, Anna‐Lena Neehus, Masato Ogishi, Vincent Meynier, Adam Krebs, Tomi Lazarov, Angela Lee, Carlos A. Arango-Franco, Rui Yang, Julio César Orrego, Melissa Corcini Berndt, Julian Rojas, Hailun Li, Darawan Rinchai, Lucía Victoria Erazo-Borrás, Ji Eun Han, Bethany Pillay, Khoren Ponsin, Matthieu Chaldebas, Quentin Philippot, Jonathan Bohlen, Jérémie Rosain, Tom Le Voyer, Till Janotte, Krishnajina Amarajeeva, Camille Soudée, Marion Brollo, Katja Wiegmann, Quentin Marquant, Yoann Seeleuthner, Danyel Lee, Candice Lainé, Doreen Kloos, Rasheed Bailey, Paul Bastard, Narelle Keating, Franck Rapaport, Taushif Khan, Marcela Moncada‐Vélez, María Camila Carmona, C. Obando, Jesús Alvarez, Juan Carlos Cataño, Larry Luber Martínez Rosado, Juan Pablo Sánchez, Manuela Tejada-Giraldo Biol, Anne-Sophie L’Honneur, María L. Agudelo, Lizet J. Perez‐Zapata, Diana Arboleda, Juan F. Álzate, Felipe Cabarcas, Alejandra Zuluaga, Simon J. Pelham, Armin Ensser, Monika Schmidt, Margarita María Velásquez‐Lopera, Emmanuelle Jouanguy, Anne Puel, Martin Krönke, Stefano Ghirardello, A. Borghesi, Susanta Pahari, Bertrand Boisson, Stefania Pittaluga, S. Cindy, Jean‐François Emile, Luigi D. Notarangelo, Stuart G. Tangye, Nico Marr, Nico Lachmann, Hélène Salvator, Larry S. Schlesinger, Peng Zhang, Michael S. Glickman, Carl Nathan, Frédéric Geissmann, Laurent Abel, José Luis Franco, Jacinta Bustamante, Jean‐Laurent Casanova, Stéphanie Boisson‐Dupuis
Abstract
Abstract Severe defects in human IFNγ immunity predispose individuals to both Bacillus Calmette–Guérin disease and tuberculosis, whereas milder defects predispose only to tuberculosis 1 . Here we report two adults with recurrent pulmonary tuberculosis who are homozygous for a private loss-of-function TNF variant. Neither has any other clinical phenotype and both mount normal clinical and biological inflammatory responses. Their leukocytes, including monocytes and monocyte-derived macrophages (MDMs) do not produce TNF, even after stimulation with IFNγ. Blood leukocyte subset development is normal in these patients. However, an impairment in the respiratory burst was observed in granulocyte–macrophage colony-stimulating factor (GM-CSF)-matured MDMs and alveolar macrophage-like (AML) cells 2 from both patients with TNF deficiency, TNF- or TNFR1-deficient induced pluripotent stem (iPS)-cell-derived GM-CSF-matured macrophages, and healthy control MDMs and AML cells differentiated with TNF blockers in vitro, and in lung macrophages treated with TNF blockers ex vivo. The stimulation of TNF-deficient iPS-cell-derived macrophages with TNF rescued the respiratory burst. These findings contrast with those for patients with inherited complete deficiency of the respiratory burst across all phagocytes, who are prone to multiple infections, including both Bacillus Calmette–Guérin disease and tuberculosis 3 . Human TNF is required for respiratory-burst-dependent immunity to Mycobacterium tuberculosis in macrophages but is surprisingly redundant otherwise, including for inflammation and immunity to weakly virulent mycobacteria and many other infectious agents.