Childhood herpes simplex virus 1 (HSV-1) encephalitis (HSE) is a life-threatening complication of primary infection by HSV-1, a common virus that causes innocuous infections in most children. The pathogenesis of HSE remained unclear until we recently showed that the disease may result from single-gene mutations impairing TLR3-dependent, IFN-?/?-mediated immunity to HSV-1 in the central nervous system (CNS), in some children. We described 10 patients, each carrying homozygous or heterozygous mutations in a TLR3 pathway gene. We also demonstrated that patient-specific induced pluripotent stem cells (iPSC)-derived TLR3-deficient neurons and oligodendrocytes were highly susceptible to HSV-1 infection, suggesting that impaired TLR3-IFN-mediated CNS intrinsic anti-HSV-1 immunity underlies the pathogenesis of HSE in patients with inborn errors of TLR3 immunity. HSE in other children may therefore result from a collection of single-gene inborn errors of CNS- intrinsic immunity against HSV-1, probably but not necessarily related to the TLR3-IFN circuit. Surprisingly, out of the 100 HSE children recently studied by whole exome sequencing (WES), four carry homozygous (two patients) or heterozygous (two patients) missense mutations in the gene encoding human debranching enzyme 1 (DBR1). Human DBR1 has been proposed to play a key role in the rapid turnover of lariat introns excised from pre-mRNA. Related to this observation, seven other HSE children studied carry heterozygous nonsense (two patients) or missense (five patients) mutations in the gene encoding 5'-3'exoribonuclease 1 (XRN1), a molecule closely connected to DBR1 in a host pre-mRNA decay pathway. Both DBR1 and XRN1 have particular CNS expression patterns. Although yeast Xrn1 is known as an essential antiviral molecule, it is completely unknown how DBR1 and XRN1 can control anti-HSV-1 immunity in the human CNS. We hypothesize that human DBR1 and XRN1 define a new, CNS-specific mechanism of intrinsic anti-HSV-1 immunity. The goal of the present application is to test this hypothesis at the molecular and cellular levels. The proposed work will be focused on the exploration of the specific role of DBR1 and its related genes (mainly XRN1) in CNS-intrinsic anti-viral immunity. The preliminary results further showed that dermal fibroblasts from one patient homozygous for a DBR1 I120T mutation express only very low levels of DBR1 protein and enhanced HSV-1 susceptibility, as comparing to the healthy controls tested. We will test fibroblasts from all patients carrying mutations in DBR1 or XRN1. We will investigate the antiviral activity of DBR1 and XRN1, indirectly via TLR3- or IFN-mediated immunity, or directly via the suppression of viral RNA recombination by DBR1 or XRN1, in in vitro assays. We will investigate anti-HSV-1 immune responses and HSV-1 susceptibility, both IFN-dependent or not, in patients'fibroblasts and iPSC-derived neurons deficient for DBR1 or XRN1, in comparison with those with impaired TLR3-, IFN-mediated immunity. This research will shed light on a novel molecule and cellular mechanism of the HSE pathogenesis, which will open new therapeutic avenues.
We previously provided proof-of-principle that herpes simplex encephalitis (HSE) in childhood may result from inborn errors of TLR3 immunity in some patients. Impaired TLR3-dependent immunity to HSV-1 in the central nervous system underlies the HSE pathogenesis in those patients. We now aim to test the hypothesis that pediatric HSE in other children results from other inborn errors of immunity of the CNS, by studying novel HSE- relevant single-gene lesions.