- Chan, Yi-Hao;
- Lundberg, Vanja;
- Le Pen, Jérémie;
- Yuan, Jiayi;
- Lee, Danyel;
- Pinci, Francesca;
- Volpi, Stefano;
- Nakajima, Koji;
- Bondet, Vincent;
- Åkesson, Sanna;
- Khobrekar, Noopur;
- Bodansky, Aaron;
- Du, Likun;
- Melander, Tina;
- Mariaggi, Alice-Andrée;
- Seeleuthner, Yoann;
- Saleh, Tariq;
- Chakravarty, Debanjana;
- Marits, Per;
- Dobbs, Kerry;
- Vonlanthen, Sofie;
- Hennings, Viktoria;
- Thörn, Karolina;
- Rinchai, Darawan;
- Bizien, Lucy;
- Chaldebas, Matthieu;
- Sobh, Ali;
- Özçelik, Tayfun;
- Keles, Sevgi;
- AlKhater, Suzan;
- Prando, Carolina;
- Meyts, Isabelle;
- Wilson, Michael;
- Rosain, Jérémie;
- Jouanguy, Emmanuelle;
- Aubart, Mélodie;
- Abel, Laurent;
- Mogensen, Trine;
- Pan-Hammarström, Qiang;
- Gao, Daxing;
- Duffy, Darragh;
- Cobat, Aurélie;
- Berg, Stefan;
- Notarangelo, Luigi;
- Harschnitz, Oliver;
- Rice, Charles;
- Studer, Lorenz;
- Casanova, Jean-Laurent;
- Ekwall, Olov;
- Zhang, Shen-Ying
Inherited deficiency of the RNA lariat-debranching enzyme 1 (DBR1) is a rare etiology of brainstem viral encephalitis. The cellular basis of disease and the range of viral predisposition are unclear. We report inherited DBR1 deficiency in a 14-year-old boy who suffered from isolated SARS-CoV-2 brainstem encephalitis. The patient is homozygous for a previously reported hypomorphic and pathogenic DBR1 variant (I120T). Consistently, DBR1 I120T/I120T fibroblasts from affected individuals from this and another unrelated kindred have similarly low levels of DBR1 protein and high levels of RNA lariats. DBR1 I120T/I120T human pluripotent stem cell (hPSC)-derived hindbrain neurons are highly susceptible to SARS-CoV-2 infection. Exogenous WT DBR1 expression in DBR1 I120T/I120T fibroblasts and hindbrain neurons rescued the RNA lariat accumulation phenotype. Moreover, expression of exogenous RNA lariats, mimicking DBR1 deficiency, increased the susceptibility of WT hindbrain neurons to SARS-CoV-2 infection. Inborn errors of DBR1 impair hindbrain neuron-intrinsic antiviral immunity, predisposing to viral infections of the brainstem, including that by SARS-CoV-2.