Interleukin-7 Reverses Lymphopenia and Improves T-Cell Function in Coronavirus Disease 2019 Patient With Inborn Error of Toll-Like Receptor 3: A Case Report

Monty B. Mazer, Isaiah R. Turnbull, Sydney Miles, Teresa M. Blood, Brooke Sadler, Annie Hess, Mitchell D. Botney, Robert S. Martin, James P. Bosanquet, David A. Striker, Nitin S. Anand, Michel Morre, Charles C. Caldwell, Scott C. Brakenridge, Lyle L. Moldawer, Jorge A. Di Paola, Richard S. Hotchkiss, Kenneth E. Remy

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

BACKGROUND: Immunotherapy treatment for coronavirus disease 2019 combined with antiviral therapy and supportive care remains under intense investigation. However, the capacity to distinguish patients who would benefit from immunosuppressive or immune stimulatory therapies remains insufficient. Here, we present a patient with severe coronavirus disease 2019 with a defective immune response, treated successfully with interleukin-7 on compassionate basis with resultant improved adaptive immune function. CASE SUMMARY: A previously healthy 43-year-old male developed severe acute respiratory distress syndrome due to the severe acute respiratory syndrome coronavirus 2 virus with acute hypoxemic respiratory failure and persistent, profound lymphopenia. Functional analysis demonstrated depressed lymphocyte function and few antigen-specific T cells. Interleukin-7 administration resulted in reversal of lymphopenia and improved T-cell function. Respiratory function and clinical status rapidly improved, and he was discharged home. Whole exome sequencing identified a deleterious autosomal dominant mutation in TICAM1, associated with a dysfunctional type I interferon antiviral response with increased severity of coronavirus disease 2019 disease. CONCLUSIONS: Immunoadjuvant therapies to boost host immunity may be efficacious in life-threatening severe coronavirus disease 2019 infections, particularly by applying a precision medicine approach in selecting patients expressing an immunosuppressive phenotype.

Original languageEnglish
Pages (from-to)E0500
JournalCritical Care Explorations
Volume3
Issue number7
DOIs
StatePublished - Jul 14 2021

Keywords

  • case report
  • coronavirus disease 2019
  • immunotherapy
  • interferons
  • interleukin-7
  • toll-like receptor 3

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