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Inborn errors of type I IFN immunity in patients with life-threatening COVID-19

Science

The immune system is complex and involves many genes, including those that encode cytokines known as interferons (IFNs). Individuals that lack specific IFNs can be more susceptible to infectious diseases. Furthermore, the autoantibody system dampens IFN response to prevent damage from pathogen-induced inflammation. Two studies now examine the likelihood that genetics affects the risk of severe coronavirus disease 2019 (COVID-19) through components of this system (see the Perspective by Beck and Aksentijevich). Q. Zhang et al. used a candidate gene approach and identified patients with severe COVID-19 who have mutations in genes involved in the regulation of type I and III IFN immunity. They found enrichment of these genes in patients and conclude that genetics may determine the clinical course of the infection. Bastard et al. identified individuals with high titers of neutralizing autoantibodies against type I IFN-α2 and IFN-ω in about 10% of patients with severe COVID-19 pneumonia. These autoantibodies were not found either in infected people who were asymptomatic or had milder phenotype or in healthy individuals. Together, these studies identify a means by which individuals at highest risk of life-threatening COVID-19 can be identified. Science , this issue p. [eabd4570][1], p. [eabd4585][2]; see also p. [404][3] ### INTRODUCTION Clinical outcomes of human severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection range from silent infection to lethal coronavirus disease 2019 (COVID-19). Epidemiological studies have identified three risk factors for severe disease: being male, being elderly, and having other medical conditions. However, interindividual clinical variability remains huge in each demographic category. Discovering the root cause and detailed molecular, cellular, and tissue- and body-level mechanisms underlying life-threatening COVID-19 is of the utmost biological and medical importance. ### RATIONALE We established the COVID Human Genetic Effort ([www.covidhge.com][4]) to test the general hypothesis that life-threatening COVID-19 in some or most patients may be caused by monogenic inborn errors of immunity to SARS-CoV-2 with incomplete or complete penetrance. We sequenced the exome or genome of 659 patients of various ancestries with life-threatening COVID-19 pneumonia and 534 subjects with asymptomatic or benign infection. We tested the specific hypothesis that inborn errors of Toll-like receptor 3 (TLR3)– and interferon regulatory factor 7 (IRF7)–dependent type I interferon (IFN) immunity that underlie life-threatening influenza pneumonia also underlie life-threatening COVID-19 pneumonia. We considered three loci identified as mutated in patients with life-threatening influenza: TLR3 , IRF7 , and IRF9 . We also considered 10 loci mutated in patients with other viral illnesses but directly connected to the three core genes conferring influenza susceptibility: TICAM1/TRIF , UNC93B1 , TRAF3 , TBK1 , IRF3 , and NEMO/IKBKG from the TLR3-dependent type I IFN induction pathway, and IFNAR1 , IFNAR2 , STAT1 , and STAT2 from the IRF7- and IRF9-dependent type I IFN amplification pathway. Finally, we considered various modes of inheritance at these 13 loci. ### RESULTS We found an enrichment in variants predicted to be loss-of-function (pLOF), with a minor allele frequency <0.001, at the 13 candidate loci in the 659 patients with life-threatening COVID-19 pneumonia relative to the 534 subjects with asymptomatic or benign infection ( P = 0.01). Experimental tests for all 118 rare nonsynonymous variants (including both pLOF and other variants) of these 13 genes found in patients with critical disease identified 23 patients (3.5%), aged 17 to 77 years, carrying 24 deleterious variants of eight genes. These variants underlie autosomal-recessive (AR) deficiencies ( IRF7 and IFNAR1 ) and autosomal-dominant (AD) deficiencies ( TLR3 , UNC93B1 , TICAM1 , TBK1 , IRF3 , IRF7 , IFNAR1 , and IFNAR2 ) in four and 19 patients, respectively. These patients had never been hospitalized for other life-threatening viral illness. Plasmacytoid dendritic cells from IRF7-deficient patients produced no type I IFN on infection with SARS-CoV-2, and TLR3−/−, TLR3+/−, IRF7−/−, and IFNAR1−/− fibroblasts were susceptible to SARS-CoV-2 infection in vitro. ### CONCLUSION At least 3.5% of patients with life-threatening COVID-19 pneumonia had known (AR IRF7 and IFNAR1 deficiencies or AD TLR3, TICAM1, TBK1, and IRF3 deficiencies) or new (AD UNC93B1, IRF7, IFNAR1, and IFNAR2 deficiencies) genetic defects at eight of the 13 candidate loci involved in the TLR3- and IRF7-dependent induction and amplification of type I IFNs. This discovery reveals essential roles for both the double-stranded RNA sensor TLR3 and type I IFN cell-intrinsic immunity in the control of SARS-CoV-2 infection. Type I IFN administration may be of therapeutic benefit in selected patients, at least early in the course of SARS-CoV-2 infection. ![Figure][5] Inborn errors of TLR3- and IRF7-dependent type I IFN production and amplification underlie life-threatening COVID-19 pneumonia. Molecules in red are encoded by core genes, deleterious variants of which underlie critical influenza pneumonia with incomplete penetrance, and deleterious variants of genes encoding biochemically related molecules in blue underlie other viral illnesses. Molecules represented in bold are encoded by genes with variants that also underlie critical COVID-19 pneumonia. Clinical outcome upon infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ranges from silent infection to lethal coronavirus disease 2019 (COVID-19). We have found an enrichment in rare variants predicted to be loss-of-function (LOF) at the 13 human loci known to govern Toll-like receptor 3 (TLR3)– and interferon regulatory factor 7 (IRF7)–dependent type I interferon (IFN) immunity to influenza virus in 659 patients with life-threatening COVID-19 pneumonia relative to 534 subjects with asymptomatic or benign infection. By testing these and other rare variants at these 13 loci, we experimentally defined LOF variants underlying autosomal-recessive or autosomal-dominant deficiencies in 23 patients (3.5%) 17 to 77 years of age. We show that human fibroblasts with mutations affecting this circuit are vulnerable to SARS-CoV-2. Inborn errors of TLR3- and IRF7-dependent type I IFN immunity can underlie life-threatening COVID-19 pneumonia in patients with no prior severe infection. [1]: /lookup/doi/10.1126/science.abd4570 [2]: /lookup/doi/10.1126/science.abd4585 [3]: /lookup/doi/10.1126/science.abe7591 [4]: https://www.covidhge.com [5]: pending:yes


Real-World Considerations for Deep Learning in Wireless Signal Identification Based on Spectral Correlation Function

Tekbıyık, Kürşat, Akbunar, Özkan, Ekti, Ali Rıza, Görçin, Ali, Kurt, Güneş Karabulut

arXiv.org Machine Learning

This paper proposes a convolutional neural network (CNN) model which utilizes the spectral correlation function (SCF) for wireless radio access technology identification without any prior information about bandwidth and/or the center frequency. The sensing and classification methods are applied to the baseband equivalent signals. Two different approaches are elaborated. The proposed method is implemented in two different settings; in the first setting, signals are jointly sensed and classified. Sensing and classification are conducted in a sequential manner in the second setting. The performance of both approaches is discussed in detail. The proposed method eliminates the threshold estimation processes of classical estimators. It also eliminates the need to know the distinct features of signals beforehand. Over-the-air real-world measurements are used to show the robustness and the validity of the proposed method and various wireless signals are successfully distinguished from each other without any a priori knowledge. The over-the-air real-world measurements are also shared in the format of SCF. The performance of SCF-based identification is compared with the cases when fast Fourier transform and amplitude-phase representation are used as the training inputs for CNN. The comparative performance of the proposed method is quantified by precision, recall, and F1-score metrics. Moreover, a setup to compare the performance of the proposed approach with classical cyclostationary features detection (CFD) is prepared. Measurement results indicate the superiority of the proposed method against CFD, especially at the low signal-to-noise ratio regime.


Robust and Fast Automatic Modulation Classification with CNN under Multipath Fading Channels

Tekbıyık, Kürşat, Ekti, Ali Rıza, Görçin, Ali, Kurt, Güneş Karabulut, Keçeci, Cihat

arXiv.org Machine Learning

Automatic modulation classification (AMC) has been studied for more than a quarter of a century; however, it has been difficult to design a classifier that operates successfully under changing multipath fading conditions and other impairments. Recently, deep learning (DL)-based methods are adopted by AMC systems and major improvements are reported. In this paper, a novel convolutional neural network (CNN) classifier model is proposed to classify modulation classes in terms of their families, i.e., types. The proposed classifier is robust against realistic wireless channel impairments and in relation to that when the data sets that are utilized for testing and evaluating the proposed methods are considered, it is seen that RadioML2016.10a is the main dataset utilized for testing and evaluation of the proposed methods. However, the channel effects incorporated in this dataset and some others may lack the appropriate modeling of the real-world conditions since it only considers two distributions for channel models for a single tap configuration. Therefore, in this paper, a more comprehensive dataset, named as HisarMod2019.1, is also introduced, considering real-life applicability. HisarMod2019.1 includes 26 modulation classes passing through the channels with 5 different fading types and several numbers of taps for classification. It is shown that the proposed model performs better than the existing models in terms of both accuracy and training time under more realistic conditions. Even more, surpassed their performance when the RadioML2016.10a dataset is utilized.