Antibodies against type I interferon: detection and association with severe clinical outcome in COVID‐19 patients

<jats:title>Abstract</jats:title><jats:sec><jats:title>Objectives</jats:title><jats:p>Impairment of type I interferon (IFN‐I) immunity has been reported in critically ill COVID‐19 patients. This defect can be explained in a subset of patients by the presence of circulating autoantibodies (auto‐Abs) against IFN‐I. We set out to improve the detection and the quantification of IFN‐I auto‐Abs in a cohort of critically ill COVID‐19 patients, in order to better evaluate the prevalence of these Abs as the pandemic progresses, and how they correlate with the clinical course of the disease.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>The concentration of anti<jats:bold>‐</jats:bold>IFN‐α<jats:sub>2</jats:sub> Abs was determined in the serum of 84 critically ill COVID‐19 patients who were admitted to ICU in <jats:italic>Hospices Civils de Lyon</jats:italic>, France, using a commercially available kit (Thermo Fisher, Catalog #BMS217).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 21 of 84 (25%) critically ill COVID‐19 patients had circulating anti‐IFN‐α<jats:sub>2</jats:sub> Abs above cut‐off (> 34 ng mL<jats:sup>−1</jats:sup>). Among them, 15 of 21 had Abs with neutralising activity against IFN‐α<jats:sub>2</jats:sub>, that is 15 of 84 (18%) critically ill patients. In addition, we noticed an impairment of the IFN‐I response in the majority of patients with neutralising anti‐IFN‐α<jats:sub>2</jats:sub> Abs. There was no significant difference in the clinical characteristics or outcome of with or without neutralising anti‐IFN‐α<jats:sub>2</jats:sub> auto‐Abs. We detected anti‐IFN‐α<jats:sub>2</jats:sub> auto‐Abs in COVID‐19 patients' sera throughout their ICU stay. Finally, we also found auto‐Abs against multiple subtypes of IFN‐I including IFN‐ω.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>We reported that 18% of critically ill COVID‐19 patients were positive for IFN‐I auto‐Abs, whereas all mild COVID‐19 patients were negative, confirming that the presence of these antibodies is associated with a higher risk of developing a critical COVID‐19 form.</jats:p></jats:sec>