{"doi":"10.1056/nejmoa2210665","title":"Anti–Interleukin-23 Autoantibodies in Adult-Onset Immunodeficiency","abstract":"Autoantibodies against interleukin-12 (anti–interleukin-12) are often identified in patients with thymoma, but opportunistic infections develop in only some of these patients. Interleukin-12 (with subunits p40 and p35) shares a common subunit with interleukin-23 (subunits p40 and p19). In a patient with disseminated Burkholderia gladioli infection, the identification of both anti–interleukin-23 and anti–interleukin-12 prompted further investigation. Among the patients (most of whom had thymoma) who were known to have anti–interleukin-12, we screened for autoantibodies against interleukin-23 (anti–interleukin-23). To validate the potential role of anti–interleukin-23 with respect to opportunistic infection, we tested a second cohort of patients with thymoma as well as patients without either thymoma or known anti–interleukin-12 who had unusual infections. Among 30 patients with anti–interleukin-12 who had severe mycobacterial, bacterial, or fungal infections, 15 (50%) also had autoantibodies that neutralized interleukin-23. The potency of such neutralization was correlated with the severity of these infections. The neutralizing activity of anti–interleukin-12 alone was not associated with infection. In the validation cohort of 91 patients with thymoma, the presence of anti–interleukin-23 was associated with infection status in 74 patients (81%). Overall, neutralizing anti–interleukin-23 was detected in 30 of 116 patients (26%) with thymoma and in 30 of 36 patients (83%) with disseminated, cerebral, or pulmonary infections. Anti–interleukin-23 was present in 6 of 32 patients (19%) with severe intracellular infections and in 2 of 16 patients (12%) with unusual intracranial infections, including Cladophialophora bantiana and Mycobacterium avium complex. Among patients with a variety of mycobacterial, bacterial, or fungal infections, the presence of neutralizing anti–interleukin-23 was associated with severe, persistent opportunistic infections. (Funded by the National Institute of Allergy and Infectious Diseases and others.)","journal":"New England Journal of Medicine","year":2024,"id":421541,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":29,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9542,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":523341,"name":"Anuj Kashyap","orcid":null,"position":1,"is_corresponding":false},{"id":680155,"name":"Hélène Salvator","orcid":"0000-0001-9294-5340","position":2,"is_corresponding":false},{"id":104139,"name":"Lindsey B. Rosen","orcid":"0000-0001-5894-3878","position":3,"is_corresponding":false},{"id":880136,"name":"Devon H. Colby","orcid":"0000-0003-1737-2938","position":4,"is_corresponding":false},{"id":1214378,"name":"Fatemeh Ardeshir‐Larijani","orcid":"0000-0002-7080-4835","position":5,"is_corresponding":false},{"id":373953,"name":"Patrick J. Loehrer","orcid":"0000-0002-1532-4660","position":6,"is_corresponding":false},{"id":356878,"name":"Li Ding","orcid":"0009-0000-1504-3212","position":7,"is_corresponding":false},{"id":1214379,"name":"Saúl Reyes","orcid":"0000-0002-3230-3263","position":8,"is_corresponding":false},{"id":1214380,"name":"Sean Riminton","orcid":"0000-0002-9953-9959","position":9,"is_corresponding":false},{"id":778752,"name":"Madison Ballman","orcid":null,"position":10,"is_corresponding":false},{"id":529097,"name":"Joseph M. Rocco","orcid":"0000-0003-4307-4934","position":11,"is_corresponding":false},{"id":363058,"name":"Beatriz E. Marciano","orcid":null,"position":12,"is_corresponding":false},{"id":246527,"name":"Alexandra F. Freeman","orcid":"0000-0001-7005-8345","position":13,"is_corresponding":false},{"id":592568,"name":"Sarah Browne","orcid":null,"position":14,"is_corresponding":false},{"id":362027,"name":"Amy P. Hsu","orcid":"0000-0001-6841-2122","position":15,"is_corresponding":false},{"id":424309,"name":"Adrian M. Zelazny","orcid":"0000-0003-2847-7428","position":16,"is_corresponding":false},{"id":250451,"name":"Arun Rajan","orcid":"0000-0003-2776-3385","position":17,"is_corresponding":false},{"id":241760,"name":"Irini Sereti","orcid":"0000-0002-0076-0224","position":18,"is_corresponding":false},{"id":332536,"name":"Christa S. Zerbe","orcid":"0000-0003-4219-0503","position":19,"is_corresponding":false},{"id":104225,"name":"Michail S. Lionakis","orcid":"0000-0003-4994-9500","position":20,"is_corresponding":false},{"id":104227,"name":"Steven M. Holland","orcid":"0000-0003-3207-5464","position":21,"is_corresponding":false},{"id":671953,"name":"Aristine Cheng","orcid":"0000-0002-1182-7375","position":0,"is_corresponding":true}],"reference_count":48,"raw_metadata":null,"created_at":"2026-07-19T01:57:41.370244Z","pmid":"38507753","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}