{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T13:47:36Z","timestamp":1782913656388,"version":"3.54.5"},"posted":{"date-parts":[[2026,4,2]]},"group-title":"Infectious Diseases (except HIV\/AIDS)","reference-count":76,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,6,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:p>\n                  Patients with myasthenia gravis (MG) may produce autoantibodies neutralizing type I interferons (AAN-I-IFN), which 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 not given antiviral treatment. Hypoxemic pneumonia occurred in 48 of these patients, including 22 (45.8%) with AAN-I-IFN, which neutralized both IFN-\u03b12 and IFN-\u03c9 in 14 (29.2%) patients. Six (16.2%) of the remaining 37 patients had AAN-I-IFN, neutralizing both IFN-\u03b12 and IFN-\u03c9 in three patients. The risk of hypoxemic pneumonia was greater in MG patients with AAN-I-IFN neutralizing 10 ng\/mL of both IFN-\u03b12 and IFN-\u03c9 (odds ratio and 95% confidence interval (OR [95% CI]): 12.7 [2.1-78.9],\n                  <jats:italic>p<\/jats:italic>\n                  =0. 0010) or IFN-\u03b12 at any dose (OR [95% CI]: 4.7 [1.5-15.0],\n                  <jats:italic>p<\/jats:italic>\n                  =0.0054) than in those without such autoantibodies. The risk of producing AAN-I-IFN was much higher in MG patients than in the general population (OR [95% CI]: 28.9 [10.8-77.7],\n                  <jats:italic>p<\/jats:italic>\n                  =4.9\u00d710\n                  <jats:sup>-27<\/jats:sup>\n                  ). Thymoma was found in 14 patients and increased the risk of AAN-I-IFN (64% versus 27%, (OR [95% CI]: 5.6 [1.6-19.4],\n                  <jats:italic>p<\/jats:italic>\n                  =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, which are, in turn, associated with a higher risk of developing life-threatening COVID-19 pneumonia in patients with MG.\n                <\/jats:p>\n                <jats:sec>\n                  <jats:title>Significance Statement<\/jats:title>\n                  <jats:p>Patients with myasthenia gravis (MG) have a higher risk of developing life-threatening COVID-19 pneumonia. In an international cohort of unvaccinated, untreated SARS-CoV-2-infected MG patients, we found that autoantibodies neutralizing type I interferons (AAN-I-IFN) were strongly associated with severe hypoxemic pneumonia. Thymoma further increased the risk of both AAN-I-IFN and severe disease. These findings suggest the existence of a critical immunological mechanism that could guide risk stratification and targeted interventions for MG patients during viral infections, such as COVID-19.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.03.27.26349525","type":"posted-content","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T22:55:14Z","timestamp":1775170514000},"source":"Crossref","is-referenced-by-count":0,"title":["High risk of hypoxemic COVID-19 pneumonia in myasthenia gravis patients with type I IFN autoantibodies"],"prefix":"10.64898","author":[{"given":"Adrian","family":"Gervais","sequence":"first","affiliation":[{"name":"Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France, EU"},{"name":"Paris Cit\u00e9 University, Imagine Institute, Paris, France, EU"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Astrid","family":"Marchal","sequence":"additional","affiliation":[{"name":"Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France, EU"},{"name":"Paris Cit\u00e9 University, Imagine Institute, Paris, France, EU"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis","family":"Maillard","sequence":"additional","affiliation":[{"name":"Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France, EU"},{"name":"Paris Cit\u00e9 University, Imagine Institute, Paris, France, EU"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom Le","family":"Voyer","sequence":"additional","affiliation":[{"name":"Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France, EU"},{"name":"Paris Cit\u00e9 University, Imagine Institute, Paris, France, EU"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00e9r\u00e9mie","family":"Rosain","sequence":"additional","affiliation":[{"name":"Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France, EU"},{"name":"Paris Cit\u00e9 University, Imagine Institute, Paris, France, EU"},{"name":"Study Center for Primary Immunodeficiencies, Necker Hospital for Sick Children, AP-HP, 75015 Paris, France, EU"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quentin","family":"Philipot","sequence":"additional","affiliation":[{"name":"Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France, EU"},{"name":"Paris Cit\u00e9 University, Imagine Institute, Paris, France, EU"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy","family":"Bizien","sequence":"additional","affiliation":[{"name":"Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France, EU"},{"name":"Paris Cit\u00e9 University, Imagine Institute, Paris, France, EU"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Peel","sequence":"additional","affiliation":[{"name":"St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Cederholm","sequence":"additional","affiliation":[{"name":"Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala 75237, Sweden, EU"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e9lanie","family":"Migaud","sequence":"additional","affiliation":[{"name":"Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France, EU"},{"name":"Paris Cit\u00e9 University, Imagine Institute, Paris, France, EU"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvie","family":"Pons","sequence":"additional","affiliation":[{"name":"Joint Research Unit Civils Hospices of Lyon-bioM\u00e9rieux, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-B\u00e9nite, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kahina","family":"Saker","sequence":"additional","affiliation":[{"name":"Joint Research Unit Civils Hospices of Lyon-bioM\u00e9rieux, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-B\u00e9nite, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Laforet","sequence":"additional","affiliation":[{"name":"Neurology Department, Nord\/Est\/ \u00cele-de-France Neuromuscular Reference Center, Raymond-Poincar\u00e9 Teaching Hospital, AP-HP, Garches, France, EU"},{"name":"INSERM U1179, END-ICAP, Versailles-Saint- Quentin-en-Yvelines University, Universit\u00e9 Paris Saclay, Montigny-le-Bretonneux, France, EU"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e9lodie","family":"Aubart","sequence":"additional","affiliation":[{"name":"Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France, EU"},{"name":"Paris Cit\u00e9 University, Imagine Institute, Paris, France, EU"},{"name":"Department of Pediatric Neurology, Necker Hospital for Sick Children, Paris Cit\u00e9 University, Paris, France, 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