Human TYK2 deficiency: Mycobacterial and viral infections without hyper-IgE syndrome

Kreins et al. report the identification and immunological characterization of a group of TYK2-deficient patients.

Autosomal recessive, complete TYK2 deficiency was previously described in a patient (P1) with intracellular bacterial and viral infections and features of hyper-IgE syndrome (HIES), including atopic dermatitis, high serum IgE levels, and staphylococcal abscesses. We identified seven other TYK2-deficient patients from five families and four different ethnic groups. These patients were homozygous for one of five null mutations, different from that seen in P1. They displayed mycobacterial and/or viral infections, but no HIES. All eight TYK2-deficient patients displayed impaired but not abolished cellular responses to (a) IL-12 and IFN-α/β, accounting for mycobacterial and viral infections, respectively; (b) IL-23, with normal proportions of circulating IL-17⁺ T cells, accounting for their apparent lack of mucocutaneous candidiasis; and (c) IL-10, with no overt clinical consequences, including a lack of inflammatory bowel disease. Cellular responses to IL-21, IL-27, IFN-γ, IL-28/29 (IFN-λ), and leukemia inhibitory factor (LIF) were normal. The leukocytes and fibroblasts of all seven newly identified TYK2-deficient patients, unlike those of P1, responded normally to IL-6, possibly accounting for the lack of HIES in these patients. The expression of exogenous wild-type TYK2 or the silencing of endogenous TYK2 did not rescue IL-6 hyporesponsiveness, suggesting that this phenotype was not a consequence of the TYK2 genotype. The core clinical phenotype of TYK2 deficiency is mycobacterial and/or viral infections, caused by impaired responses to IL-12 and IFN-α/β. Moreover, impaired IL-6 responses and HIES do not appear to be intrinsic features of TYK2 deficiency in humans.

Tuberculosis and impaired IL-23-dependent IFN-γ immunity in humans homozygous for a common TYK2 missense variant

Inherited IL-12Rβ1 and TYK2 deficiencies impair both IL-12- and IL-23-dependent IFN-γ immunity and are rare monogenic causes of tuberculosis, each found in less than 1/600,000 individuals. We show that homozygosity for the common TYK2 P1104A allele, which is found in about 1/600 Europeans and between 1/1000 and 1/10,000 individuals in regions other than East Asia, is more frequent in a cohort of patients with tuberculosis from endemic areas than in ethnicity-adjusted controls (P = 8.37 × 10^-8; odds ratio, 89.31; 95% CI, 14.7 to 1725). Moreover, the frequency of P1104A in Europeans has decreased, from about 9% to 4.2%, over the past 4000 years, consistent with purging of this variant by endemic tuberculosis. Surprisingly, we also show that TYK2 P1104A impairs cellular responses to IL-23, but not to IFN-α, IL-10, or even IL-12, which, like IL-23, induces IFN-γ via activation of TYK2 and JAK2. Moreover, TYK2 P1104A is properly docked on cytokine receptors and can be phosphorylated by the proximal JAK, but lacks catalytic activity. Last, we show that the catalytic activity of TYK2 is essential for IL-23, but not IL-12, responses in cells expressing wild-type JAK2. In contrast, the catalytic activity of JAK2 is redundant for both IL-12 and IL-23 responses, because the catalytically inactive P1057A JAK2, which is also docked and phosphorylated, rescues signaling in cells expressing wild-type TYK2. In conclusion, homozygosity for the catalytically inactive P1104A missense variant of TYK2 selectively disrupts the induction of IFN-γ by IL-23 and is a common monogenic etiology of tuberculosis.

Impaired IL-23-dependent induction of IFN-γ underlies mycobacterial disease in patients with inherited TYK2 deficiency

Human cells homozygous for rare loss-of-expression (LOE) TYK2 alleles have impaired, but not abolished, cellular responses to IFN-α/β (underlying viral diseases in the patients) and to IL-12 and IL-23 (underlying mycobacterial diseases). Cells homozygous for the common P1104A TYK2 allele have selectively impaired responses to IL-23 (underlying isolated mycobacterial disease). We report three new forms of TYK2 deficiency in six patients from five families homozygous for rare TYK2 alleles (R864C, G996R, G634E, or G1010D) or compound heterozygous for P1104A and a rare allele (A928V). All these missense alleles encode detectable proteins. The R864C and G1010D alleles are hypomorphic and loss-of-function (LOF), respectively, across signaling pathways. By contrast, hypomorphic G996R, G634E, and A928V mutations selectively impair responses to IL-23, like P1104A. Impairment of the IL-23-dependent induction of IFN-γ is the only mechanism of mycobacterial disease common to patients with complete TYK2 deficiency with or without TYK2 expression, partial TYK2 deficiency across signaling pathways, or rare or common partial TYK2 deficiency specific for IL-23 signaling.

Interactions between autologous CD4+ and CD8+ T lymphocytes and human squamous cell carcinoma of the head and neck

The autotumor (AuTu)-specific cytolytic T lymphocyte (CTL) line established from the peripheral blood of a patient with oral squamous cell carcinoma (Cancer Res. 53, 1461, 1993) contained >95% of CD8+ and <5% of CD4+ T cells. This CTL line was infected with Herpesvirus saimiri to increase its life span in culture. Two transformed T cell sublines were obtained: the monoclonal CD4+ line (TCR Vbeta2+ V alpha15+) and the oligoclonal CD8+ line (TCR Vbeta6+, Vbeta7+ and Vbeta9+) both of which were maintained in culture for >6 months without AuTu restimulation and which did not produce any virus. The virus-transformed and untransformed T cell lines were compared for phenotypic and functional characteristics, including the ability to kill AuTu, induce expression of the major histocompatibility complex (MHC) antigens on AuTu, and respond to AuTu by cytokine production and/or proliferation. The H. saimiri-transformed CD4+ T cells expressed higher levels of surface adhesion molecules and CD45RO than untransformed cells and lysed AuTu by inducing DNA fragmentation as well as necrosis. This lysis was inhibited by antibodies to CD4 but not to class I or II MHC molecules. The CD4+ T cells produced IL2, TNF-alpha, and GM-CSF and proliferated in response to AuTu. They induced and sustained proliferation of CD8+ T cells in cocultures with AuTu. Supernatants obtained from cocultures of the CD4+ T cells with AuTu also induced proliferation of the CD8+ T cell line. In contrast, the H. saimiri-transformed CD8+ T cells did not kill AuTu or release cytokines in response to AuTu. However, upon pretreatment of AuTu with IFN-gamma to increase expression of MHC antigens, these T cells regained the ability to recognize and kill AuTu targets. Coincubation of AuTu with the CD4+ or CD8+ T cells significantly augmented expression of class I and II MHC antigens on AuTu. These data indicate that H. saimiri-transformed tumor-reactive T cell lines provide a useful model of interactions between immune effector cells and AuTu, and that CD4+ T cells play a critical role in the regulation of immune responses to squamous cell carcinoma of the head and neck.