Transient anti-interferon autoantibodies in the airways are associated with recovery from COVID-19

Sci Transl Med. 2024 Nov 6;16(772):eadq1789. doi: 10.1126/scitranslmed.adq1789. Epub 2024 Nov 6.

Abstract

Preexisting anti-interferon-α (anti-IFN-α) autoantibodies in blood are associated with susceptibility to life-threatening COVID-19. However, it is unclear whether anti-IFN-α autoantibodies in the airways, the initial site of infection, can also determine disease outcomes. In this study, we developed a multiparameter technology, FlowBEAT, to quantify and profile the isotypes of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and anti-IFN-α antibodies in longitudinal samples collected over 20 months from the airways and blood of 129 donors spanning mild to severe COVID-19. We found that nasal IgA1 anti-IFN-α autoantibodies were induced after infection onset in more than 70% of mild and moderate COVID-19 cases and were associated with robust anti-SARS-CoV-2 immunity, fewer symptoms, and efficient recovery. Nasal anti-IFN-α autoantibodies followed the peak of host IFN-α production and waned with disease recovery, revealing a regulated balance between IFN-α and anti-IFN-α response. In contrast, systemic IgG1 anti-IFN-α autoantibodies appeared later and were detected only in a subset of patients with elevated systemic inflammation and worsening symptoms. These data reveal a protective role for nasal anti-IFN-α in the immunopathology of COVID-19 and suggest that anti-IFN-α autoantibodies may serve a homeostatic function to regulate host IFN-α after viral infection in the respiratory mucosa.

MeSH terms

  • Adult
  • Autoantibodies* / blood
  • Autoantibodies* / immunology
  • COVID-19* / immunology
  • COVID-19* / virology
  • Female
  • Humans
  • Immunoglobulin A / blood
  • Immunoglobulin A / immunology
  • Immunoglobulin G / blood
  • Immunoglobulin G / immunology
  • Interferon-alpha* / immunology
  • Male
  • Middle Aged
  • Respiratory System / immunology
  • Respiratory System / virology
  • SARS-CoV-2* / immunology

Substances

  • Autoantibodies
  • Interferon-alpha
  • Immunoglobulin A
  • Immunoglobulin G