Accumulated ISG15 Drives Immune Pathology and Respiratory Failure During Systemic Viral Infection

Type 1 interferon provides potent antiviral defense but unchecked IFN-I signaling can lead to pathology or immune suppression. The mechanisms by which IFN-I contributes to disease pathogenesis remain poorly understood. Here, using Usp18-deficient, USP18 enzymatic-inactive and Isg15-deficient mouse models, we report that lack of USP18 enzymatic function during persistent viral infection leads to severe immune pathology characterized by hematological disruptions, pulmonary cytokine amplification, lung vascular leakage and death. Lack of Usp18 in myeloid cells mimicked the pathological manifestations observed in Usp18-/- or Usp18C61A knock-in mice and required Isg15. Mechanistically, interrupting the enzymes that conjugate/deconjugate ISG15 led to accumulation of ISG15 which was accompanied by inflammatory neutrophil accumulation and lung pathology. Moreover, neutrophil depletion reversed pathological manifestations, morbidity and mortality in Usp18C61A mice. Our results suggest that dysregulated ISG15 signaling during viral infection can produce lethal immune pathology and could be a therapeutic target during severe viral infections with pulmonary pathological manifestations.