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Anti-IFN- Autoantibodies in Disseminated Nontuberculous Mycobacterial Infections

Smita Y. Patel^*, Li Ding^*, Margaret R. Brown, Larry Lantz, Ted Gay, Stuart Cohen^¶, Lenna A. Martyak^||, Bernard Kubak^|| and Steven M. Holland^1,*

^* Immunopathogenesis Section, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892; Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD 20892; Research Technologies Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892; Tri City Medical Center, Oceanside, CA 92056; ^¶ University of California, Davis School of Medicine, Sacramento, CA 95817; and ^|| University of California, Los Angeles School of Medicine, Los Angeles, CA 90095

Although many patients with disseminated nontuberculous mycobacterial disease have molecular defects in the IFN-/IL-12 axis, recent case reports have shown autoantibodies against IFN- associated with severe nontuberculous mycobacterial infections. To check this finding in an independent population, we screened 35 patients with either disseminated or pulmonary nontuberculous mycobacterial infections for whom no molecular defect was known. We identified high-titer-neutralizing anti-IFN- IgG in the plasma of six patients. All six patients were female, parous, of East Asian descent, and had disseminated infection, predominantly with rapidly growing mycobacteria. The anti-IFN- IgG had in vitro biological activity on the IFN--dependent phosphorylation of STAT-1 as well as on the IFN--dependent up-regulation of TNF- and IL-12. In contrast, this anti-IFN- Ab had no effect on IFN--dependent STAT-1 phosphorylation. These patients confirm a novel syndrome linking autoimmunity and immunodeficiency.

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