Abstract
Patients with myasthenia gravis (MG) may produce autoantibodies neutralizing type I interferons (AAN-I-IFN), which have been shown to underlie severe viral diseases, including critical COVID-19 pneumonia, in patients without MG. We studied an international cohort of 85 unvaccinated SARS-CoV-2-infected MG patients with no antiviral treatment. Hypoxemic pneumonia occurred in 48 of these patients, including 22 (45.8%) with AAN-I-IFN, which neutralized both IFN-α2 and IFN-ω in 14 (29.2%) patients. Six (16.2%) of the remaining 37 patients had AAN-I-IFN, which neutralized both IFN-α2 and IFN-ω in three patients. The risk of hypoxemic pneumonia was greater in MG patients with AAN-I-IFN neutralizing 10 ng/mL of both IFN-α2 and IFN-ω (odds ratio and 95% confidence interval (OR [95% CI]): 12.7 [2.1-78.9], p=0. 0010) or IFN-α2 at any dose (4.7 [1.5-15.0], p=0.0054) than in those without such autoantibodies. The risk of AAN-I-IFN production was much higher in MG patients than in the general population (28.9 [10.8-77.7], p=4.9x10-27). Fourteen patients had thymoma, which increased the risk of AAN-I-IFN (64% versus 27%, (OR [95% CI]: 5.6 [1.6-19.4], p=0.0050) and hypoxemic pneumonia (9.2 [1.9-44.2]; p=0.0019). Thymoma is, thus, associated with a higher risk of producing AAN-I-IFN, and these autoantibodies are associated with a higher risk of developing life-threatening COVID-19 pneumonia in patients with MG.
Competing Interest Statement
J.-L. C. is an inventor on patent application PCT/US2021/042741, filed July 22, 2021, submitted by The Rockefeller University and covering the diagnosis of susceptibility to, and the treatment of, viral disease, and viral vaccines, including COVID-19 and vaccine-associated diseases. None of the other authors has any conflict of interest to declare.
Funding Statement
The Laboratory of Human Genetics of Infectious Diseases is supported by the Howard Hughes Medical Institute, the Rockefeller University, the St. Giles Foundation, the National Institutes of Health (NIH) (R01AI163029), the National Center for Advancing Translational Sciences (NCATS), NIH Clinical and Translational Science Award (CTSA) program (UL1TR001866), the Fisher Center for Alzheimer s Research Foundation, the Meyer Foundation, the JPB Foundation, the Stavros Niarchos Foundation (SNF) as part of its grant to the SNF Institute for Global Infectious Disease Research at The Rockefeller University, the French Agence Nationale de la Recherche (ANR) under the France 2030 program (ANR-10-IAHU-01), the Integrative Biology of Emerging Infectious Diseases Laboratory of Excellence (ANR-10-LABX-62-IBEID), the French Foundation for Medical Research (FRM) (EQU202503020018), the ANR-RHU program ANR-21-RHUS-0008, ANR GENVIR (ANR-20-CE93-0003), ANR AABIFNCOV (ANR-20-CO11-0001) and ANR GenMISC (ANR-21-COVR-0039), AI2D (ANR-22-CE15-0046) projects, the European Union s Horizon 2020 research and innovation program under grant agreement no. 824110 (EASI-genomics), the HORIZON-HLTH-2021-DISEASE-04 program under grant agreement 101057100 (UNDINE), the Square Foundation, Grandir - Fonds de solidarite pour l enfance, the Fondation du Souffle, the SCOR Corporate Foundation for Science, the Battersea and Bowery Advisory Group; The French Ministry of Higher Education, Research, and Innovation (MESRI-COVID-19), William E. Ford, General Atlantic s Chairman and Chief Executive Officer, Gabriel Caillaux, General Atlantic s Co-President, Managing Director and Head of Business in EMEA, and the General Atlantic Foundation, Institut National de la Sante et de la Recherche Medicale (INSERM), REACTing-INSERM and Paris Cite University. For the collection and biobanking of MG samples, RLP and FT acknowledge support provided by the FP6 program (MYASTAID, LSHM-CT-2006-037833), FIGHT-MG (HEALTH-2009-242-210). N.L. was supported by the Swedish Research Council (no 2021-03118) and the Goran Gustafsson Foundation (no 2141 and 2247). TLV was supported by a Poste CCA-INSERM-Bettencourt (with the support of the Fondation Bettencourt-Schueller). P.B. was supported by the French Foundation for Medical Research (FRM, EA20170638020), the MD-PhD program of the Imagine Institute (with the support of the Fondation Bettencourt-Schueller), and a Poste CCA-INSERM-Bettencourt (with the support of the Fondation Bettencourt-Schueller).
Source:
Link: https://www.medrxiv.org/content/10.64898/2026.03.27.26349525v1
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