[HTML][HTML] TLR7 gain-of-function genetic variation causes human lupus

GJ Brown, PF Cañete, H Wang, A Medhavy, J Bones… - Nature, 2022 - nature.com
GJ Brown, PF Cañete, H Wang, A Medhavy, J Bones, JA Roco, Y He, Y Qin, J Cappello…
Nature, 2022nature.com
Although circumstantial evidence supports enhanced Toll-like receptor 7 (TLR7) signalling
as a mechanism of human systemic autoimmune disease,,,,,–, evidence of lupus-causing
TLR7 gene variants is lacking. Here we describe human systemic lupus erythematosus
caused by a TLR7 gain-of-function variant. TLR7 is a sensor of viral RNA, and binds to
guanosine,–. We identified a de novo, previously undescribed missense TLR7 Y264H
variant in a child with severe lupus and additional variants in other patients with lupus. The …
Abstract
Although circumstantial evidence supports enhanced Toll-like receptor 7 (TLR7) signalling as a mechanism of human systemic autoimmune disease, , , , , –, evidence of lupus-causing TLR7 gene variants is lacking. Here we describe human systemic lupus erythematosus caused by a TLR7 gain-of-function variant. TLR7 is a sensor of viral RNA, and binds to guanosine, –. We identified a de novo, previously undescribed missense TLR7Y264H variant in a child with severe lupus and additional variants in other patients with lupus. The TLR7Y264H variant selectively increased sensing of guanosine and 2',3'-cGMP, –, and was sufficient to cause lupus when introduced into mice. We show that enhanced TLR7 signalling drives aberrant survival of B cell receptor (BCR)-activated B cells, and in a cell-intrinsic manner, accumulation of CD11c+ age-associated B cells and germinal centre B cells. Follicular and extrafollicular helper T cells were also increased but these phenotypes were cell-extrinsic. Deficiency of MyD88 (an adaptor protein downstream of TLR7) rescued autoimmunity, aberrant B cell survival, and all cellular and serological phenotypes. Despite prominent spontaneous germinal-centre formation in Tlr7Y264H mice, autoimmunity was not ameliorated by germinal-centre deficiency, suggesting an extrafollicular origin of pathogenic B cells. We establish the importance of TLR7 and guanosine-containing self-ligands for human lupus pathogenesis, which paves the way for therapeutic TLR7 or MyD88 inhibition.
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