背景:自身抗体介导的血细胞减少症(AIC)经常发生在严重缺乏IgG的常见可变免疫缺陷(CVID)患者中。同种型,抗原靶标,其致病自身抗体的来源尚不清楚。
目的:为了确定反应性,CVID患者中AIC相关IgM自身抗体的克隆性和来源。
方法:我们利用聚糖阵列,患者红细胞,和血小板以确定CVIDIgM自身抗体的靶标。聚糖结合谱用于鉴定跨B细胞亚群的自反应性克隆,特别是循环边缘区样(MZ)B细胞,用于分选和IGH测序。Thelocations,通过共聚焦显微镜确定扁桃体MZB细胞对不同T辅助细胞亚群的转录组和反应,RNA测序,和共同文化,分别。
结果:许多具有AIC(CVIDAIC)的CVID患者的自身反应性IgM包被的红细胞和血小板。在聚糖阵列上,CVIDAIC血浆IgM狭窄地识别红细胞i抗原和血小板i相关抗原,并且未能结合数百种病原体和肿瘤相关的碳水化合物。多克隆I抗原识别B细胞受体在CVIDAIC循环边缘区(MZ)B细胞中高度富集。在扁桃体组织内,当被IL-10和IL-21的组合激活时或当与分泌IL10/IL-21的FOXP3-CD25hiTfh细胞一起培养时,MZB细胞分泌大量IgM。在免疫活性对照的淋巴结中,MZB细胞,丰富的FOXP3+调节性T细胞,和罕见的FOXP3-CD25+细胞,可能代表CD25hiTfh细胞,全部位于GC之外。在CVID+AIC淋巴结中,细胞位置相似,但CD25hiTfh细胞数量大大超过调节细胞。
结论:我们的研究结果表明,在GC外产生的聚糖反应性IgM自身抗体可能与CVID的自身免疫发病机制有关。
BACKGROUND: Autoimmune cytopenias (AICs) regularly occur in profoundly IgG-deficient patients with common variable immunodeficiency (CVID). The isotypes, antigenic targets, and origin(s) of their disease-causing autoantibodies are unclear.
OBJECTIVE: We sought to determine reactivity, clonality, and provenance of AIC-associated IgM autoantibodies in patients with CVID.
METHODS: We used glycan arrays, patient erythrocytes, and platelets to determine targets of CVID IgM autoantibodies. Glycan-binding profiles were used to identify autoreactive clones across B-cell subsets, specifically circulating marginal zone (MZ) B cells, for sorting and IGH sequencing. The locations, transcriptomes, and responses of tonsillar MZ B cells to different TH- cell subsets were determined by confocal microscopy, RNA-sequencing, and cocultures, respectively.
RESULTS: Autoreactive IgM coated erythrocytes and platelets from many CVID patients with AICs (CVID+AIC). On glycan arrays, CVID+AIC plasma IgM narrowly recognized erythrocytic i antigens and platelet i-related antigens and failed to bind hundreds of pathogen- and tumor-associated carbohydrates. Polyclonal i antigen-recognizing B-cell receptors were highly enriched among CVID+AIC circulating MZ B cells. Within tonsillar tissues, MZ B cells secreted copious IgM when activated by the combination of IL-10 and IL-21 or when cultured with IL-10/IL-21-secreting FOXP3-CD25hi T follicular helper (Tfh) cells. In lymph nodes from immunocompetent controls, MZ B cells, plentiful FOXP3+ regulatory T cells, and rare FOXP3-CD25+ cells that represented likely CD25hi Tfh cells all localized outside of germinal centers. In CVID+AIC lymph nodes, cellular positions were similar but CD25hi Tfh cells greatly outnumbered regulatory cells.
CONCLUSIONS: Our findings indicate that glycan-reactive IgM autoantibodies produced outside of germinal centers may contribute to the autoimmune pathogenesis of CVID.