Selective predisposition to bacterial infections in IRAK-4-deficient children: IRAK-4-dependent TLRs are otherwise redundant in protective immunity

Cheng Lung Ku, Horst Von Bernuth, Capucine Picard, Shen Ying Zhang, Huey Hsuan Chang, Kun Yang, Maya Chrabieh, Andrew C. Issekutz, Coleen K. Cunningham, John Gallin, Steven M. Holland, Chaim Roifman, Stephan Ehl, Joanne Smart, Mimi Tang, Franck J. Barrat, Ofer Levy, Douglas McDonald, Noorbibi K. Day-Good, Richard MillerHidetoshi Takada, Toshiro Hara, Sami Al-Hajjar, Abdulaziz Al-Ghonaium, David Speert, Damien Sanlaville, Xiaoxia Li, Frédéric Geissmann, Eric Vivier, László Maródi, Ben Zion Garty, Helen Chapel, Carlos Rodriguez-Gallego, Xavier Bossuyt, Laurent Abel, Anne Puel, Jean Laurent Casanova

Research output: Contribution to journalArticlepeer-review

346 Citations (Scopus)


Human interleukin (IL) 1 receptor-associated kinase 4 (IRAK-4) deficiency is a recently discovered primary immunodeficiency that impairs Toll/IL-1R immunity, except for the Toll-like receptor (TLR) 3- and TLR4-interferon (IFN)-α/β pathways. The clinical and immunological phenotype remains largely unknown. We diagnosed up to 28 patients with IRAK-4 deficiency, tested blood TLR responses for individual leukocyte subsets, and TLR responses for multiple cytokines. The patients' peripheral blood mononuclear cells (PBMCs) did not induce the 11 non-IFN cytokines tested upon activation with TLR agonists other than the nonspecific TLR3 agonist poly(I:C). The patients' individual cell subsets from both myeloid (granulocytes, monocytes, monocyte-derived dendritic cells [MDDCs], myeloid DCs [MDCs], and plasmacytoid DCs) and lymphoid (B, T, and NK cells) lineages did not respond to the TLR agonists that stimulated control cells, with the exception of residual responses to poly(I:C) and lipopolysaccharide in MDCs and MDDCs. Most patients (22 out of 28; 79%) suffered from invasive pneumococcal disease, which was often recurrent (13 out of 22; 59%). Other infections were rare, with the exception of severe staphylococcal disease (9 out of 28; 32%). Almost half of the patients died (12 out of 28; 43%). No death and no invasive infection occurred in patients older than 8 and 14 yr, respectively. The IRAK-4-dependent TLRs and IL-1Rs are therefore vital for childhood immunity to pyogenic bacteria, particularly Streptococcus pneumoniae. Conversely, IRAK-4-dependent human TLRs appear to play a redundant role in protective immunity to most infections, at most limited to childhood immunity to some pyogenic bacteria. JEM

Original languageEnglish
Pages (from-to)2407-2422
Number of pages16
JournalJournal of Experimental Medicine
Issue number10
Publication statusPublished - Oct 1 2007
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology


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