Exome sequencing identifies novel mutations in the Toll-like receptor 3 pathway contributing to herpes simplex encephalitis susceptibility (P1403)

Abstract

Abstract Herpes simplex encephalitis is a rare manifestation of herpes simplex virus-1 infection. Mutations in genes of the toll-like receptor 3-interferon pathway have been shown to predispose to childhood herpes simplex encephalitis, including UNC93B1, TLR3, TRIF, TRAF3 and TBK1. We investigated herpes simplex encephalitis patients with impaired toll-like receptor 3 signaling for whom the involvement of the known genetic etiologies have been excluded. Exome sequencing was used to identify other mutations underlying herpes simplex encephalitis, paying particular attention to the toll-like receptor 3-interferon pathway by employing a candidate gene based ‘connectome’ approach. One patient in particular carried a novel heterozygous missense mutation in a known gene in the nuclear factor-κB / toll-like receptor 3 pathway. The patient’s cells showed a decrease in interferon regulatory factor-3 dimerization and reduced nuclear translocation of nuclear factor-κB consistent with the lack of type I interferon and IL6 production following toll-like receptor 3 stimulation. The patients’ cells were also more susceptible upon viral infections. Further characterization of the mutation and its impact on type I interferon signaling in the context of herpes simplex virus-1 infection will provide a better understanding of the etiology of childhood herpes simplex encephalitis.