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B-Cells and BAFF in Primary Antiphospholipid Syndrome, Targets for Therapy? J Clin Med 2022; 12:jcm12010018. [PMID: 36614819 PMCID: PMC9821657 DOI: 10.3390/jcm12010018] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/04/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Primary antiphospholipid syndrome (PAPS) is a systemic autoimmune disease characterized by thrombosis, pregnancy morbidity, and the presence of antiphospholipid antibodies (aPL). Anticoagulants form the mainstay of treatment in PAPS. A growing number of studies suggest a previously underappreciated role of the immune system in the pathophysiology of PAPS. Although B-cells are strongly implicated in the pathophysiology of other autoimmune diseases such as systemic lupus erythematosus (SLE), little is known about the role of B-cells in PAPS. Shifts in B-cell subsets including increases in plasmablasts and higher levels of BAFF are present in patients with PAPS. However, while treatment with rituximab and belimumab may ameliorate thrombotic and non-thrombotic manifestations of PAPS, these treatments do not reduce aPL serum levels, suggesting that B-cells contribute to the pathophysiology of APS beyond the production of autoantibodies.
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Dieudonné Y, Guffroy A, Poindron V, Sprauel PS, Martin T, Korganow AS, Gies V. B cells in primary antiphospholipid syndrome: Review and remaining challenges. Autoimmun Rev 2021; 20:102798. [PMID: 33722752 DOI: 10.1016/j.autrev.2021.102798] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 01/03/2021] [Indexed: 02/03/2023]
Abstract
It is now widely accepted that antiphospholipid antibodies (aPL) have direct pathogenic effects and that B cells, notably through aPL production, play a key role in the development of antiphospholipid syndrome (APS). Recent findings strengthened the implication of B cells with the description of specific B cell phenotype abnormalities and inborn errors of immunity involving B cell signaling in APS patients. In addition, it has been shown in preclinical models that cross-reactivity between APS autoantigens and mimotopes expressed by human gut commensals can lead to B cell tolerance breakdown and are sufficient for APS development. However, B cell targeting therapies are surprisingly not as effective as expected in APS compared to other autoimmune diseases. Elucidation of the B cell tolerance breakdown mechanisms in APS patients may help to develop and guide the use of novel therapeutic agents that target B cells or specific immune pathway.
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Affiliation(s)
- Yannick Dieudonné
- Université de Strasbourg, INSERM UMR - S1109, F-67000 Strasbourg, France; Hôpitaux Universitaires de Strasbourg, Department of Clinical Immunology and Internal Medicine, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Tertiary Center for Primary Immunodeficiencies, F-67000 Strasbourg, France; Université de Strasbourg, Faculty of Medicine, F-67000 Strasbourg, France.
| | - Aurélien Guffroy
- Université de Strasbourg, INSERM UMR - S1109, F-67000 Strasbourg, France; Hôpitaux Universitaires de Strasbourg, Department of Clinical Immunology and Internal Medicine, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Tertiary Center for Primary Immunodeficiencies, F-67000 Strasbourg, France; Université de Strasbourg, Faculty of Medicine, F-67000 Strasbourg, France
| | - Vincent Poindron
- Université de Strasbourg, INSERM UMR - S1109, F-67000 Strasbourg, France; Hôpitaux Universitaires de Strasbourg, Department of Clinical Immunology and Internal Medicine, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Tertiary Center for Primary Immunodeficiencies, F-67000 Strasbourg, France; Université de Strasbourg, Faculty of Medicine, F-67000 Strasbourg, France
| | - Pauline Soulas Sprauel
- Université de Strasbourg, INSERM UMR - S1109, F-67000 Strasbourg, France; Hôpitaux Universitaires de Strasbourg, Department of Clinical Immunology and Internal Medicine, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Tertiary Center for Primary Immunodeficiencies, F-67000 Strasbourg, France; Université de Strasbourg, Faculty of Pharmacy, F-67400 Illkirch, France
| | - Thierry Martin
- Université de Strasbourg, INSERM UMR - S1109, F-67000 Strasbourg, France; Hôpitaux Universitaires de Strasbourg, Department of Clinical Immunology and Internal Medicine, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Tertiary Center for Primary Immunodeficiencies, F-67000 Strasbourg, France; Université de Strasbourg, Faculty of Medicine, F-67000 Strasbourg, France
| | - Anne-Sophie Korganow
- Université de Strasbourg, INSERM UMR - S1109, F-67000 Strasbourg, France; Hôpitaux Universitaires de Strasbourg, Department of Clinical Immunology and Internal Medicine, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Tertiary Center for Primary Immunodeficiencies, F-67000 Strasbourg, France; Université de Strasbourg, Faculty of Medicine, F-67000 Strasbourg, France
| | - Vincent Gies
- Université de Strasbourg, INSERM UMR - S1109, F-67000 Strasbourg, France; Hôpitaux Universitaires de Strasbourg, Department of Clinical Immunology and Internal Medicine, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Tertiary Center for Primary Immunodeficiencies, F-67000 Strasbourg, France; Université de Strasbourg, Faculty of Pharmacy, F-67400 Illkirch, France
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3
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Tissue factor pathway inhibitor primes monocytes for antiphospholipid antibody-induced thrombosis. Blood 2019; 134:1119-1131. [PMID: 31434703 DOI: 10.1182/blood.2019001530] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/06/2019] [Indexed: 12/28/2022] Open
Abstract
Antiphospholipid antibodies (aPLs) with complex lipid and/or protein reactivities cause complement-dependent thrombosis and pregnancy complications. Although cross-reactivities with coagulation regulatory proteins contribute to the risk for developing thrombosis in patients with antiphospholipid syndrome, the majority of pathogenic aPLs retain reactivity with membrane lipid components and rapidly induce reactive oxygen species-dependent proinflammatory signaling and tissue factor (TF) procoagulant activation. Here, we show that lipid-reactive aPLs activate a common species-conserved TF signaling pathway. aPLs dissociate an inhibited TF coagulation initiation complex on the cell surface of monocytes, thereby liberating factor Xa for thrombin generation and protease activated receptor 1/2 heterodimer signaling. In addition to proteolytic signaling, aPLs promote complement- and protein disulfide isomerase-dependent TF-integrin β1 trafficking that translocates aPLs and NADPH oxidase to the endosome. Cell surface TF pathway inhibitor (TFPI) synthesized by monocytes is required for TF inhibition, and disabling TFPI prevents aPL signaling, indicating a paradoxical prothrombotic role for TFPI. Myeloid cell-specific TFPI inactivation has no effect on models of arterial or venous thrombus development, but remarkably prevents experimental aPL-induced thrombosis in mice. Thus, the physiological control of TF primes monocytes for rapid aPL pathogenic signaling and thrombosis amplification in an unexpected crosstalk between complement activation and coagulation signaling.
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Su X, Wang A, Zhu H, Su H, Duan Y, Wu S, Zhang M, Huang Y, Zhou X, Cao Y. Acute myocardial infarction and transient elevated anticardiolipin antibody in a young adult with possible familial hypercholesterolemia: a case report : Anticardiolipin antibody and myocardial infarction. BMC Cardiovasc Disord 2019; 19:156. [PMID: 31248367 PMCID: PMC6598355 DOI: 10.1186/s12872-019-1135-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 06/12/2019] [Indexed: 11/23/2022] Open
Abstract
Background Familial hypercholesterolemia (FH) can lead to premature coronary heart disease. Anticardiolipin antibody may be a contributor for thrombosis. Here, we report an adult with possible FH suffered from premature myocardial infarction that may be triggered by transient increased anticardiolipin antibody. Case presentation A 29-year-old male had presented with a history of 2-h chest pain and numbness of left upper arm before 5 days. The electrocardiogram (ECG) had demonstrated inferior wall myocardial infarction (MI). Five days later he was admitted to our hospital and diagnosed as acute MI and possible FH (premature coronary heart disease, low density lipoprotein cholesterol of 5.90 mmol/L) with increased anticardiolipin antibody (up to 120 RU/ml). Other auto-antibodies including β2-glicoprotein antibodies IgM, IgA, IgG, lupus anticoagulant (LA), antinuclear antibodies, anti-myocardial antibody were normal. Coronary artery angiography (CAG) showed right coronary artery was total occlusion from the middle segment. Then he underwent percutaneous coronary intervention with a stent. Four days later, he was discharged with complete recovery. CAG showed intra-stent restenosis and anticardiolipin antibody level was normal and the patient had no any symptoms at 6-month follow-up. Conclusions Transient elevated anticardiolipin antibody may be a trigger or biomarker of cardiac thrombotic events in younger atherosclerotic patients.
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Affiliation(s)
- Xin Su
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou University, Lanzhou, 730000, People's Republic of China.,School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, 730000, People's Republic of China
| | - Aqian Wang
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou University, Lanzhou, 730000, People's Republic of China.,School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, 730000, People's Republic of China
| | - Hai Zhu
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou University, Lanzhou, 730000, People's Republic of China
| | - Hongling Su
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou University, Lanzhou, 730000, People's Republic of China
| | - Yichao Duan
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou University, Lanzhou, 730000, People's Republic of China.,School of Clinical Medicine, Ningxia Medical University, Lanzhou, 730000, People's Republic of China
| | - Shanlian Wu
- School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, 730000, People's Republic of China
| | - Min Zhang
- Department of Pathology, Gansu Provincial Hospital, Lanzhou University, Lanzhou, 730000, People's Republic of China
| | - Yan Huang
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou University, Lanzhou, 730000, People's Republic of China
| | - Xing Zhou
- Department of Radiology, Gansu Provincial Hospital, Lanzhou University, Lanzhou, 730000, People's Republic of China.
| | - Yunshan Cao
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou University, Lanzhou, 730000, People's Republic of China.
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Antiphospholipid antibodies and renal transplant: A systematic review and meta-analysis. Semin Arthritis Rheum 2019; 48:1041-1052. [DOI: 10.1016/j.semarthrit.2018.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/09/2018] [Accepted: 10/15/2018] [Indexed: 12/12/2022]
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6
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Mobarrez F, Gunnarsson I, Svenungsson E. Altered β 2 -glycoprotein I expression on microparticles in the presence of antiphospholipid antibodies. J Thromb Haemost 2017; 15:1799-1806. [PMID: 28667788 DOI: 10.1111/jth.13765] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/08/2017] [Indexed: 01/15/2023]
Abstract
Essentials β2 glycoprotein-I (β2 GPI) is a scavenger molecule that binds to microparticles (MPs). β2 GPI expression on MPs was measured in systemic lupus erythematosus (SLE) patients and controls. β2 GPI positive MPs is depressed among SLE patients positive for antiphospholipid antibodies. Complex formation between β2 GPI on MPs and patients own anti-β2 GPI may disturb MP clearance. Click to hear an ISTH Academy presentation on antiphospholipid antibody syndrome by Drs de Laat and Bertolaccini SUMMARY: Background Antiphospholipid antibodies (aPLs) together with thrombosis and/or pregnancy morbidities characterize the antiphospholipid syndrome. β2 -Glycoprotein I (β2 GPI), the most important antigen for aPLs, is a scavenger molecule that specifically binds to phosphatidylserine (PS) expressed on microparticles (MPs). Objectives To evaluate β2 GPI-expressing MPs in patients with systemic lupus erythematosus (SLE) stratified for aPL status, and in healthy controls. Patients/Methods We investigated 18 aPL/anti-β2 GPI-positive and 22 aPL-negative patients from a large SLE cohort and 19 healthy controls. β2 GPI-positive MPs and IgG-positive MPs were detected by flow cytometry. We measured plasma levels of β2 GPI, and performed in vitro experiments to investigate the binding properties of β2 GPI on MPs. Results SLE patients had more MPs and IgG-positive MPs than controls. We observed fewer β2 GPI-positive MPs in aPL/anti-β2 GPI-positive patients than in aPL/anti-β2 GPI-negative patients and controls (approximately two-fold). β2 GPI levels in plasma did not differ with aPL/anti-β2 GPI status in patients; however, controls had slightly higher levels of β2 GPI than aPL/anti-β2 GPI-positive patients. In vitro experiments revealed that β2 GPI preferentially binds to PS-positive MPs. Conclusions Despite abundant total MPs and MPs in immune complexes, β2 GPI-positive MPs were depleted in SLE patients, and the levels were especially low in aPL/anti-β2 GPI-positive patients. We suggest that anti-β2 GPI antibodies bind to β2 GPI-PS complexes expressed on MPs. Consequent loss of β2 GPI-PS expression on MPs may impair scavenging and contribute to the accumulation of circulating PS-negative MPs, a possible source of autoantigens. Autoantibodies delaying MP clearance may thus constitute an important mechanism underlying autoimmunity.
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Affiliation(s)
- F Mobarrez
- Unit of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - I Gunnarsson
- Unit of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - E Svenungsson
- Unit of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Shi X, Qu Z, Zhang L, Zhang N, Liu Y, Li M, Qiu J, Jiang Y. Increased ratio of ICOS(+) /PD-1(+) follicular helper T cells positively correlates with the development of human idiopathic membranous nephropathy. Clin Exp Pharmacol Physiol 2016; 43:410-6. [PMID: 26845249 DOI: 10.1111/1440-1681.12555] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 12/22/2015] [Accepted: 01/29/2016] [Indexed: 01/26/2023]
Abstract
To identify the frequencies of different subsets of peripheral blood follicular helper T (Tfh) cells in human idiopathic membranous nephropathy (IMN), 39 patients with new onset IMN and 18 age- and gender-matched healthy controls (HC) were enrolled for this study. The frequency of Tfh cells in venous blood were measured by flow cytometry, while concentration of serum IL-21 was detected by enzyme-linked immunosorbent assay. Correlation between the clinical features of IMN and Tfh cells was assessed by Spearman's rank correlation test. Overall, the frequencies of total, ICOS(+) , and PD-1(+) Tfh cells were increased in IMN patients, while the ratio of ICOS(+) /PD-1(+) Tfh cells positively correlated with IMN progression. However, the elevated serum IL-21 level in three subgroups of IMN patients, stratified based on 24-h urine protein levels, was not statistically significant compared to HC. Nonetheless, intracellular IL-21 in Tfh cells was generally increased in all IMN patients, and closely correlated with IMN development. Finally, the frequency of IL-21(+) Tfh cells and the ratio of ICOS(+) /PD-1(+) Tfh cells were positively correlated with the estimated 24-h urine protein of IMN patients. The data indicated that Tfh cells contribute to the pathogenicity of IMN. The ratio of ICOS(+) /PD-1(+) Tfh cells and the frequency of IL-21(+) Tfh cells may be indicators for evaluating the IMN development.
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Affiliation(s)
- Xu Shi
- Genetic Diagnosis Centre, Central Laboratory, Ministry of Education, First Hospital, Jilin University, Changchun, China
| | - Zhihui Qu
- Department of Nephrology, Ministry of Education, First Hospital, Jilin University, Changchun, China
| | - Li Zhang
- Department of Nephrology, Ministry of Education, First Hospital, Jilin University, Changchun, China
| | - Nan Zhang
- Genetic Diagnosis Centre, Central Laboratory, Ministry of Education, First Hospital, Jilin University, Changchun, China
| | - Yong Liu
- Genetic Diagnosis Centre, Central Laboratory, Ministry of Education, First Hospital, Jilin University, Changchun, China
| | - Man Li
- Genetic Diagnosis Centre, Central Laboratory, Ministry of Education, First Hospital, Jilin University, Changchun, China
| | - Jinpeng Qiu
- Genetic Diagnosis Centre, Central Laboratory, Ministry of Education, First Hospital, Jilin University, Changchun, China
| | - Yanfang Jiang
- Genetic Diagnosis Centre, Central Laboratory, Ministry of Education, First Hospital, Jilin University, Changchun, China.,Key Laboratory of Zoonosis Research, Ministry of Education, First Hospital, Jilin University, Changchun, China.,Jiangsu Co-innovation Centre for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, China
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8
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Antiphospholipid Antibodies: Their Origin and Development. Antibodies (Basel) 2016; 5:antib5020015. [PMID: 31557996 PMCID: PMC6698834 DOI: 10.3390/antib5020015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 05/18/2016] [Accepted: 05/19/2016] [Indexed: 11/25/2022] Open
Abstract
Antiphospholipid antibodies (aPL) are a hallmark of the antiphospholipid syndrome (APS), which is the most commonly acquired thrombophilia. To date there is consensus that aPL cause the clinical manifestations of this potentially devastating disorder. However, there is good evidence that not all aPL are pathogenic. For instance, aPL associated with syphilis show no association with the manifestations of APS. While there has been intensive research on the pathogenetic role of aPL, comparably little is known about the origin and development of aPL. This review will summarize the current knowledge and understanding of the origin and development of aPL derived from animal and human studies.
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9
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van den Hoogen LL, van Roon JAG, Radstake TRDJ, Fritsch-Stork RDE, Derksen RHWM. Delineating the deranged immune system in the antiphospholipid syndrome. Autoimmun Rev 2015; 15:50-60. [PMID: 26318678 DOI: 10.1016/j.autrev.2015.08.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 08/24/2015] [Indexed: 12/16/2022]
Abstract
The antiphospholipid syndrome (APS) is a systemic autoimmune disease that is characterized serologically by the presence of antiphospholipid antibodies (aPL) and clinically by vascular thrombosis and obstetric complications. The protein β2 glycoprotein I (β2GPI) is identified as the most important autoantigen in this syndrome. Activation of endothelial cells, thrombocytes and placental tissue by anti-β2GPI antibodies relates to the clinical manifestations of APS. This review describes genetic and environmental factors in relation to APS and summarizes the current knowledge on abnormalities in components of both the innate and adaptive immune system in APS. The role of dendritic cells, T-cells, B-cells, monocytes, neutrophils and NK-cells as well as the complement system in APS are discussed. Several gaps in our knowledge on the pathophysiology of APS are identified and a plea is made for future extensive immune cell profiling by a systems medicine approach in order to better unravel the pathogenesis of APS, to gain more insight in the role of the immune system in APS as well as having the potential to reveal biomarkers or novel therapeutic targets.
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Affiliation(s)
- Lucas L van den Hoogen
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; Laboratory of Translational Immunology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Joël A G van Roon
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; Laboratory of Translational Immunology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Timothy R D J Radstake
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; Laboratory of Translational Immunology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Ruth D E Fritsch-Stork
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Ronald H W M Derksen
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Evasion and interactions of the humoral innate immune response in pathogen invasion, autoimmune disease, and cancer. Clin Immunol 2015; 160:244-54. [PMID: 26145788 DOI: 10.1016/j.clim.2015.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 06/22/2015] [Accepted: 06/26/2015] [Indexed: 02/07/2023]
Abstract
The humoral innate immune system is composed of three major branches, complement, coagulation, and natural antibodies. To persist in the host, pathogens, such as bacteria, viruses, and cancers must evade parts of the innate humoral immune system. Disruptions in the humoral innate immune system also play a role in the development of autoimmune diseases. This review will examine how Gram positive bacteria, viruses, cancer, and the autoimmune conditions systemic lupus erythematosus and anti-phospholipid syndrome, interact with these immune system components. Through examining evasion techniques it becomes clear that an interplay between these three systems exists. By exploring the interplay and the evasion/disruption of the humoral innate immune system, we can develop a better understanding of pathogenic infections, cancer, and autoimmune disease development.
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Ben-Chetrit E, Wiener-Well Y, Fadeela A, Wolf DG. Antiphospholipid antibodies during infectious mononucleosis and their long term clinical significance. J Clin Virol 2013; 56:312-5. [PMID: 23290387 DOI: 10.1016/j.jcv.2012.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 12/05/2012] [Accepted: 12/10/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The prevalence of antiphospholipid antibodies (aPLs) during acute Epstein-Barr virus (EBV) infection may be as high as 30-60%. The role of these autoantibodies in the development of antiphospholipid syndrome (APS) is not clear. OBJECTIVE To investigate the prevalence, persistence and clinical significance of aPLs in a series of patients diagnosed with acute EBV infection. STUDY DESIGN A cohort of 94 patients aged 15 or older, recently diagnosed with acute EBV was retrieved. Serum samples obtained during diagnosis were tested for the presence of aPLs and anti-β2GP antibodies. Patients with positive sera for aPLs were assessed for the persistence of aPLs and the development of APS. RESULTS The prevalence of aPLs among 94 patients with acute EBV was 37.2%. Five of 27 available serum samples were also positive for anti-β2 glycoprotein (anti-β2GP) antibodies. Repeat testing for aPLs after a median of 21 months post acute infection (range 13-50 months) was performed in 17 of the 35 patients with positive aPL test. All 17 patients were found negative for aPL-IgG antibodies. Two of them had positive aPL-IgM antibodies and positive anti-β2GP antibodies. None of the patients who had positive aPLs experienced any manifestations of APS. CONCLUSION The disappearance of aPLs in the majority of the patients after acute EBV infection, along with the absence of consistent clinical findings, suggests that the detection of aPLs during acute EBV is not associated with the development APS over time.
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Affiliation(s)
- Eli Ben-Chetrit
- Infectious Diseases Unit, Shaare Zedek Medical Center affiliated with the Hebrew University Hadassah Medical School, Jerusalem, Israel.
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12
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Abstract
The antiphospholipid syndrome (APS) is diagnosed when patients with thrombotic complications or foetal losses have elevated levels of antiphospholipid antibodies in their plasmas. The term APS is confusing, because the pathogenic auto-antibodies are not directed against phospholipids but towards a plasma protein, β(2)-glycoprotein I. For many years the reason why auto-antibodies against β(2)-glycoprotein I were pro-thrombotic was unclear, because man and mice deficient in β(2)-glycoprotein I do not express a clear phenotype. Animal models in which passive transfer of patient antibodies into mice resulted in an increased thrombotic response have provided novel insights in the importance of this protein in the pathology of APS.
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Affiliation(s)
- P G de Groot
- Department of Clinical Chemistry and Haematology, University Medical Center, Utrecht, The Netherlands.
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13
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Abstract
The antiphospholipid syndrome (APS) is defined by the persistent presence of antiphospholipid antibodies in patients with a history of thrombosis and/or pregnancy morbidity, including fetal loss. APS is an autoimmune disease with a confusing name because the pathologic auto-antibodies are shown to be directed against the plasma protein β(2)-glycoprotein I and not against phospholipids. In fact, auto-antibodies that recognize phospholipids themselves are not associated with thrombosis but with infectious diseases. One of the intriguing questions is why autoantibodies against β(2)-glycoprotein I are so commonly found in both patients and the healthy. Several potential mechanisms have been suggested to explain the increased thrombotic risk in patients with these autoantibodies. In this overview, we will summarize our knowledge on the etiology of the autoantibodies, and we will discuss the evidence that identify autoantibodies against β(2)-glycoprotein I as the culprit of APS.
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14
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Cérutti M, Golay J. Lepidopteran cells, an alternative for the production of recombinant antibodies? MAbs 2012; 4:294-309. [PMID: 22531440 DOI: 10.4161/mabs.19942] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Monoclonal antibodies are used with great success in many different therapeutic domains. In order to satisfy the growing demand and to lower the production cost of these molecules, many alternative systems have been explored. Among them, the baculovirus/insect cells system is a good candidate. This system is very safe, given that the baculoviruses have a highly restricted host range and they are not pathogenic to vertebrates or plants. But the major asset is the speed with which it is possible to obtain very stable recombinant viruses capable of producing fully active proteins whose glycosylation pattern can be modulated to make it similar to the human one. These features could ultimately make the difference by enabling the production of antibodies with very low costs. However, efforts are still needed, in particular to increase production rates and thus make this system commercially viable for the production of these therapeutic agents.
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Affiliation(s)
- Martine Cérutti
- CNRS UPS3044 Baculovirus et Thérapie, CNRS GDR3260, ACCITH Anticorps et Ciblage Thérapeutique and LabEx MabImprove, Saint Christol Lèz Alès, France.
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15
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De Groot PG, Meijers JCM, Urbanus RT. Recent developments in our understanding of the antiphospholipid syndrome. Int J Lab Hematol 2012; 34:223-31. [PMID: 22394675 DOI: 10.1111/j.1751-553x.2012.01414.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The antiphospholipid syndrome is an autoimmune disease that manifests clinically as recurrent thrombotic complications or foetal losses and serologically with elevated levels of antiphospholipid antibodies in the plasmas of these patients. The term 'antiphospholipid syndrome' is confusing, because the auto-antibodies are not directed against phospholipids but towards a plasma protein, β(2) -glycoprotein I. For many years, the reason why auto-antibodies against β(2) -glycoprotein I were pro-thrombotic was unclear, because β(2) -glycoprotein I seems to be an obsolete protein in our circulation. Human and mice deficient in this protein do not express a clear phenotype. Recent studies on the structure and function of β(2) -glycoprotein I have provided novel insights into the importance of this protein in physiology and its role in the pathology of the antiphospholipid syndrome.
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Affiliation(s)
- P G De Groot
- Department of Clinical Chemistry and Haematology, University Medical Center, Utrecht, The Netherlands.
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Pasquali JL, Martin T. Control of B cells expressing naturally occurring autoantibodies. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 750:145-56. [PMID: 22903672 DOI: 10.1007/978-1-4614-3461-0_11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Naturally occurring autoantibodies (NAbs) are typically polyreactive, bind with low affinity to a discrete set of autoantigens and are encoded by variable region genes in germline configuration. They differ from disease-associated autoantibodies (autoAb), which are mostly monoreactive, somatically mutated and of high affinities. Structure-function studies have shown that polyreactivity of NAbs relies on the somatically generated complementarity determining region, CDR3, of the heavy chain. This finding suggested that NAb-producing B cells were positively selected from the pre-immune B-cell repertoire. The biological significance of this selection remains, however, unclear. Data originating mainly from transgenic mice have shown that mature NAb-producing B cells are frequently ignorant toward their antigen, possibly due to their low affinity, though active tolerance mechanisms are not excluded. An important issue is whether NAb-producing B cells constitute the pool from which pathologic auto Ab emerge after autoantigen-driven maturation. We summarize results obtained in mouse models, showing that some infectious agents are able to induce an autoantigen-driven activation of certain NAb-producing B cells. However direct proof that selection by autoantigen may lead to somatic hypermutation are still lacking. Other data tend to suggest that pathologic auto Abs may derive from non-autoimmune B cells that have diversified by somatic hypermutation of their variable region genes.
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Affiliation(s)
- Jean Louis Pasquali
- Clinical Immunology Department, National Referral Center for Systemic Autoimmune Diseases, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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17
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Pasquali JL, Sibilia J, Poindron V, Korganow AS, Soulas-Sprauel P, Martin T. [Immunological aspects of the antiphospholipid syndrome]. Rev Med Interne 2011; 33:189-93. [PMID: 22000274 DOI: 10.1016/j.revmed.2011.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 08/11/2011] [Indexed: 11/16/2022]
Abstract
Antiphospholipid antibodies constitute a group of heterogeneous antibodies, which mainly recognize complexes made of proteins and anionic phospholipids. The nature of these complexes is currently better defined, as well as known, the structure of the antiphospholipid antibodies owing to the analysis of the monoclonal forms of these antibodies which were also studied both in terms of their precise specificities and cross-reactivity. However, the origin of these autoantibodies is not clearly understood, as well as the possible link between antiphospholipid antibodies present in healthy individuals, and those observed in autoimmune diseases. Only a fraction of antiphospholipid antibodies are pathogenic and directly responsible for the clinical manifestations of the antiphospholipid syndrome, but there is, to date, no biological test able to accurately detect pathogenic antiphospholipid antibodies. The diverse mechanisms which link these autoantibodies to the occurrence of symptoms, mainly during obstetrical complications, are better understood, and suggest new therapeutic avenues.
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Affiliation(s)
- J-L Pasquali
- Service de médecine interne et immunologie clinique, centre national de référence pour les maladies auto-immunes rares, nouvel hôpital civil, hôpitaux universitaires de Strasbourg, place de l'Hôpital, 67091 Strasbourg, France.
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18
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Poindron V, Berat R, Knapp AM, Toti F, Zobairi F, Korganow AS, Chenard MP, Gounou C, Pasquali JL, Brisson A, Martin T. Evidence for heterogeneity of the obstetric antiphospholipid syndrome: thrombosis can be critical for antiphospholipid-induced pregnancy loss. J Thromb Haemost 2011; 9:1937-47. [PMID: 21848640 DOI: 10.1111/j.1538-7836.2011.04475.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Antiphospholipid antibodies are associated with thrombosis and repeated pregnancy losses during the antiphospholipid syndrome. Several experimental findings indicate that purified antiphospholipid antibodies are directly responsible for inflammation-induced pregnancy losses, or for disruption of the annexin A5 shield at the trophoblastic interface. We previously showed that passive transfer of CIC15, a monoclonal antiphospholipid antibody binding to cardiolipin and annexin A5 that was isolated from a patient with primary antiphospholipid syndrome, induces fetal resorption in pregnant mice. OBJECTIVES To investigate the mechanisms of CIC15-induced pregnancy loss. METHODS/RESULTS We show that CIC15 induces fetal loss through a new mechanism that is probably related to procoagulant activity. The time course is different from those of previously described models, and histologic analysis shows that the placentas are devoid of any sign of inflammation but display some signs of thrombotic events. Despite these differences, the CIC15 and 'inflammatory' models share some similarities: lack of FcγRI/III dependency, and the efficacy of heparin in preventing fetal losses. However, this latter observation is here mostly attributable to anticoagulation rather than complement inhibition, because fondaparinux sodium and hirudin show similar efficiency. In vitro, CIC15 enhances cardiolipin-induced thrombin generation. Finally, using a combination of surface-sensitive methods, we show that, although it binds complexes of cardiolipin-annexin A5, CIC15 is not able to disrupt the two-dimensional ordered arrays of annexin A5. CONCLUSIONS This human monoclonal antibody is responsible for pregnancy loss through a new mechanism involving thrombosis. This mechanism adds to the heterogeneity of the obstetric antiphospholipid syndrome.
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Affiliation(s)
- V Poindron
- National Referral Center for Systemic Autoimmune Diseases, Clinical Immunology Department, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg and CNRS UPR 9021, Strasbourg, France.
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19
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Yoshida T, Mei H, Dörner T, Hiepe F, Radbruch A, Fillatreau S, Hoyer BF. Memory B and memory plasma cells. Immunol Rev 2010; 237:117-39. [PMID: 20727033 DOI: 10.1111/j.1600-065x.2010.00938.x] [Citation(s) in RCA: 215] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Vaccination provides a powerful means to control infections. It exploits and exemplifies the ability of the immune system to preserve the information that a specific pathogen has been encountered in the past. The cells and molecular mechanisms of immunological memory are still being discussed controversially. Here, we review the current concepts of memory B cells, the signals involved in their maintenance, and their role in enhanced secondary reactions. Memory plasma cells, secreting protective antibodies over lifetime, have been recognized only recently. Their characterization as cells resting in terms of proliferation and migration, and surviving in dedicated stromal niches, in the absence of antigen, has generated new concepts of how memory cells in general are organized by stroma cells, the 'resting memory'. In autoimmunity and chronic inflammation, memory B cells and memory plasma cells can be essential players, and they require special attention, as they do not respond to most conventional therapies. Their selective targeting will depend on a molecular understanding of their lifestyle.
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Affiliation(s)
- Taketoshi Yoshida
- Charité Centre 12, Clinic for Internal Medicine, Rheumatology, Clinical Immunology, Charité University Hospital Berlin, Berlin, Germany
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20
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Chronic lymphocytic leukemia antibodies with a common stereotypic rearrangement recognize nonmuscle myosin heavy chain IIA. Blood 2008; 112:5122-9. [PMID: 18812466 DOI: 10.1182/blood-2008-06-162024] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Leukemic B lymphocytes of a large group of unrelated chronic lymphocytic leukemia (CLL) patients express an unmutated heavy chain immunoglobulin variable (V) region encoded by IGHV1-69, IGHD3-16, and IGHJ3 with nearly identical heavy and light chain complementarity-determining region 3 sequences. The likelihood that these patients developed CLL clones with identical antibody V regions randomly is highly improbable and suggests selection by a common antigen. Monoclonal antibodies (mAbs) from this stereotypic subset strongly bind cytoplasmic structures in HEp-2 cells. Therefore, HEp-2 cell extracts were immunoprecipitated with recombinant stereotypic subset-specific CLL mAbs, revealing a major protein band at approximately 225 kDa that was identified by mass spectrometry as nonmuscle myosin heavy chain IIA (MYHIIA). Reactivity of the stereotypic mAbs with MYHIIA was confirmed by Western blot and immunofluorescence colocalization with anti-MYHIIA antibody. Treatments that alter MYHIIA amounts and cytoplasmic localization resulted in a corresponding change in binding to these mAbs. The appearance of MYHIIA on the surface of cells undergoing stress or apoptosis suggests that CLL mAb may generally bind molecules exposed as a consequence of these events. Binding of CLL mAb to MYHIIA could promote the development, survival, and expansion of these leukemic cells.
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21
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[Physiopathology of the antiphospholipid syndrome]. Rev Med Interne 2007; 28 Suppl 4:S302-3. [PMID: 17964695 DOI: 10.1016/j.revmed.2007.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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22
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Abstract
The antiphospholipid syndrome is characterized by the association of clinical events (thrombosis and/or obstetrical complications) and heterogeneous autoantibodies reacting with complexes of proteins and anionic phospholipids. Most of these recognized proteins can bind to anionic phospholipids and play a role in natural regulation of coagulation. Inhibition by these autoantibodies of the natural regulators of excessive coagulation is probably responsible for the prothrombotic state that characterizes this disease. Animal models have helped explain the mechanisms of obstetrical complications. Human antiphospholipid antibodies passively transferred to pregnant mice directly cause fetal resorption. This effect is mediated by complement fractions and neutrophil activation and is inhibited by heparin. The origin of these autoantibodies is still debated. Physiologically, the cause may be associated with exposure to anionic phospholipids on the surface of apoptotic cells. The affinity maturation process, which leads to the acquisition of somatic mutations, can then generate highly pathogenic antiphospholipid antibodies.
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Affiliation(s)
- Jean-Louis Pasquali
- Service de Médecine Interne et Immunologie Clinique, Hôpitaux Universitaires, Strasbourg.
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23
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Stamatopoulos K, Belessi C, Moreno C, Boudjograh M, Guida G, Smilevska T, Belhoul L, Stella S, Stavroyianni N, Crespo M, Hadzidimitriou A, Sutton L, Bosch F, Laoutaris N, Anagnostopoulos A, Montserrat E, Fassas A, Dighiero G, Caligaris-Cappio F, Merle-Béral H, Ghia P, Davi F. Over 20% of patients with chronic lymphocytic leukemia carry stereotyped receptors: Pathogenetic implications and clinical correlations. Blood 2006; 109:259-70. [PMID: 16985177 DOI: 10.1182/blood-2006-03-012948] [Citation(s) in RCA: 382] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The chronic lymphocytic leukemia (CLL) immunoglobulin repertoire is biased and characterized by the existence of subsets of cases with closely homologous ("stereotyped") complementarity-determining region 3 (CDR3) sequences. In the present series, 201 (21.9%) of 916 patients with CLL expressed IGHV genes that belonged to 1 of 48 different subsets of sequences with stereotyped heavy chain (H) CDR3. Twenty-six subsets comprised 3 or more sequences and were considered "confirmed." The remaining subsets comprised pairs of sequences and were considered "potential"; public database CLL sequences were found to be members of 9 of 22 "potential" subsets, thereby allowing us to consider them also "confirmed." The chance of belonging to a subset exceeded 35% for unmutated or selected IGHV genes (eg, IGHV1-69/3-21/4-39). Comparison to non-CLL public database sequences showed that HCDR3 restriction is "CLL-related." CLL cases with selected stereotyped immunoglobulins (IGs) were also found to share unique biologic and clinical features. In particular, cases expressing stereotyped IGHV4-39/IGKV1-39-1D-39 and IGHV4-34/IGKV2-30 were always IgG-switched. In addition, IGHV4-34/IGKV2-30 patients were younger and followed a strikingly indolent disease, contrasting other patients (eg, those expressing IGHV3-21/IGLV3-21) who experienced an aggressive disease, regardless of IGHV mutations. These findings suggest that a particular antigen-binding site can be critical in determining the clinical features and outcome for at least some CLL patients.
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MESH Headings
- ADP-ribosyl Cyclase 1/analysis
- Amino Acid Sequence
- B-Lymphocyte Subsets/immunology
- B-Lymphocyte Subsets/pathology
- Base Sequence
- Cohort Studies
- Epitopes
- Follow-Up Studies
- France
- Gene Frequency
- Gene Rearrangement, B-Lymphocyte, Heavy Chain
- Genes, Immunoglobulin
- Greece
- Humans
- Immunoglobulin Class Switching
- Immunoglobulin Heavy Chains/genetics
- Immunoglobulin Switch Region
- Immunoglobulin Variable Region/genetics
- Italy
- Leukemia, Lymphocytic, Chronic, B-Cell/etiology
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Molecular Sequence Data
- Polymerase Chain Reaction
- Rheumatoid Factor/immunology
- Sequence Homology
- Somatic Hypermutation, Immunoglobulin
- Spain
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Affiliation(s)
- Kostas Stamatopoulos
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
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24
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Bose B, Sinha S. Problems in using statistical analysis of replacement and silent mutations in antibody genes for determining antigen-driven affinity selection. Immunology 2005; 116:172-83. [PMID: 16162266 PMCID: PMC1817819 DOI: 10.1111/j.1365-2567.2005.02208.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The analysis of molecular signatures of antigen-driven affinity selection of B cells is of immense use in studies on normal and abnormal B cell development. Most of the published literature compares the expected and observed frequencies of replacement (R) and silent (S) mutations in the complementarity-determining regions (CDRs) and the framework regions (FRs) of antibody genes to identify the signature of antigenic selection. The basic assumption of this statistical method is that antigenic selection creates a bias for R mutations in the CDRs and for S mutations in the FRs. However, it has been argued that the differences in intrinsic mutability among different regions of an antibody gene can generate a statistically significant bias even in the absence of any antigenic selection. We have modified the existing statistical method to include the effects of intrinsic mutability of different regions of an antibody gene. We used this method to analyse sequences of several B cell-derived monoclonals against T-dependent antigens, T-independent antigens, clones derived from lymphoma and amyloidogenic clones. Our sequence analysis indicates that even after correcting for the intrinsic mutability of antibody genes, statistical parameters fail to reflect the role of antigen-driven affinity selection in maturation of many clones. We suggest that, contrary to the basic assumption of such statistical methods, selection can act both for and against R mutations in the CDR as well as in the FR regions. In addition we have identified different methodological difficulties in the current uses of such statistical analysis of antibody genes.
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Affiliation(s)
- Biplab Bose
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
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25
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Soulas P, Woods A, Jaulhac B, Knapp AM, Pasquali JL, Martin T, Korganow AS. Autoantigen, innate immunity, and T cells cooperate to break B cell tolerance during bacterial infection. J Clin Invest 2005; 115:2257-67. [PMID: 16041408 PMCID: PMC1177998 DOI: 10.1172/jci24646] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2005] [Accepted: 05/24/2005] [Indexed: 01/01/2023] Open
Abstract
Autoantibody production during infections is considered to result from nonspecific activation of low-affinity autoreactive B cells. Whether this can lead to autoimmune disease remains uncertain. We show that chronic infection by Borrelia burgdorferi of Tg animals expressing human rheumatoid factor (RF) B cells (of low or intermediate affinities) in the absence or in the constitutive presence of the autoantigen (represented here by chimeric IgG with human constant region) breaks their state of immunological ignorance, leading to the production of RFs. Surprisingly, this production was more pronounced in intermediate-affinity RF Tg mice co-expressing the autoantigen. This overproduction was mediated by immune complexes and involved synergistic signaling between the B cell receptor and Toll-like receptors and T cell help. These findings indicate that chronic infection can activate autoreactive B cells with significant affinity and creates conditions that can drive them to differentiate into memory cells. Such cells may have some physiological yet undetermined role, but in autoimmune-prone individuals, this scenario may initiate autoimmunity.
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Affiliation(s)
- Pauline Soulas
- Laboratoire d'Immunopathologie, INSERM U737, Centre de Recherche d'Immunologie et d'Hématologie, Hôpital Civil, Strasbourg Cedex, France
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26
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Bozic B, Cucnik S, Kveder T, Rozman B. Avidity of anti-beta-2-glycoprotein I antibodies. Autoimmun Rev 2005; 4:303-8. [PMID: 15990078 DOI: 10.1016/j.autrev.2005.01.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2004] [Accepted: 01/01/2005] [Indexed: 11/16/2022]
Abstract
The terms affinity and avidity are often used indiscriminately, despite clearly differing. Since affinity refers to monovalent binding of antibodies to a monovalent epitope, the majority of data on the binding of anti-beta2-glycoprotein I antibodies (anti-beta2-GPI) characterized their avidity rather than affinity. Anti-beta2-GPI were generally believed to be of low avidity, but heterogeneous avidity of patients' IgG anti-beta2-GPI has been demonstrated. High avidity anti-beta2-GPI monoclonals were reported to possess higher pathogenicity than low avidity anti-beta2-GPI. Polyclonal high avidity anti-beta2-GPI were found to be more common in patients with antiphospholipid syndrome (APS) and associated with thrombosis. Some conformational changes of beta2-GPI are required for the binding of polyclonal anti-beta2-GPI to the antigen: neither high density of the antigen nor high avidity of the anti-beta2-GPI alone is sufficient for the recognition. Avidity of anti-beta2-GPI should be considered in any attempt of inter-laboratory standardisation and/or evaluation of anti-beta2-GPI enzyme-linked immunosorbent assay (ELISA).
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Affiliation(s)
- B Bozic
- University Medical Centre, Division of Internal Medicine, Department of Rheumatology, Vodnikova 62, SI-1000, Ljubljana, Slovenia.
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27
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Youinou P, Renaudineau Y. The antiphospholipid syndrome as a model for B cell-induced autoimmune diseases. Thromb Res 2005; 114:363-9. [PMID: 15507266 DOI: 10.1016/j.thromres.2004.06.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2004] [Revised: 06/11/2004] [Accepted: 06/15/2004] [Indexed: 02/08/2023]
Abstract
Growing awareness of the pathophysiological importance of B cells for antiphospholipid antibody syndrome (APS), particularly those expressing the T cell marker CD5, has recently led to the proposal that their tolerance may be used as a method to reduce specific antibody (Ab) production. B cell tolerance has indeed become one of the most exciting developments in the treatment of this disease. Based on their production of multispecific Ab, these CD5+ B lymphocytes, also referred to as B-1 cells, are thought to account for most of the AutoAb in autoimmune murine models. Raised numbers of circulating CD5+ B cells correlate with high levels of anti-phospholipid (PL) Ab in some APS patients, and participate in altered immunity of women with recurrent spontaneous abortion. These findings are not surprising in view of the cross-reaction with PL of anti-bromelain-treated erythrocyte Ab secreted by these cells. Transgenic animals have, however, shown that B lymphocytes contribute to such disorders through a variety of characteristics other than Ab production. Indeed, owing to the role of the CD5 molecule in the maintenance of clonal anergy, increased proportions of B-1 cells may merely reflect their defective regulation through CD5 itself. Various B cell receptor (BCR)-associated transmembrane glycoproteins are also involved in the behavior of the cells. These include CD19 which amplifies the message, and CD22 which dampens down the BCR signaling. In addition, B lymphocytes may act as potent antigen-presenting cells for autoantigens, all the more because they secrete an excess of autocrine-acting interleukin-10 in autoimmune states. Furthermore, by modifying the specificity of their BCR, not only in the bone-marrow, but also in the secondary lymphoid organs, autoreactive B cells may initiate new immunoglobulin rearrangements. It is interesting that self-reactive Ab-making cells present with such rearrangements. Finally, B cells have the capacity to polarize into B effector (Be)-1 and Be-2, with different cytokine patterns that regulate the levels of T helper (Th)-1 and Th-2, respectively. Such a cytokine might be defective in nonorgan-specific autoimmune diseases. In conclusion, B lymphocytes are required for the initiation of anti-self Ab-associated disorders, such as APS. Their classical view in the biology of immune responses to self as autoAb secreting cells turns out to be rather naive, and an essential role for B lymphocytes may not be producing autoAb.
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Affiliation(s)
- Pierre Youinou
- Laboratory of Immunology, Brest University Medical School Hospital, 5 av Foch CHU Morvan BP 824, F 29609 Brest Cedex, France.
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28
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Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss recent publications dealing with the control of autoreactive B cells, how this control is subverted in human systemic lupus erythematosus and in murine models of systemic lupus erythematosus, and how dysregulated autoreactive B cells may then contribute to disease expression through both regulatory and effector mechanisms. RECENT FINDINGS Autoreactive B cells are abundant in the mature peripheral B-cell repertoire and need to be censored to avoid autoimmunity. This censoring is accomplished in diverse ways and may be broken down by multiple mechanisms both intrinsic and extrinsic to the B cells. SUMMARY The work reviewed here paints a suggestive picture while confirming the pathogenic potential of autoreactive B cells and pointing to specific defects that warrant further exploration and could represent future therapeutic targets for this autoimmune disease.
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Affiliation(s)
- Jennifer Anolik
- Department of Medicine, Clinical Immunology and Rheumatology Unit, Rochester, New York 14642, USA
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29
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Lieby P, Poindron V, Roussi S, Klein C, Knapp AM, Garaud JC, Cerutti M, Martin T, Pasquali JL. Pathogenic antiphospholipid antibody: an antigen-selected needle in a haystack. Blood 2004; 104:1711-5. [PMID: 15166038 DOI: 10.1182/blood-2004-02-0462] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Antiphospholipid antibodies represent a heterogeneous group of autoantibodies directed against anionic phospholipids (PLs) usually linked to protein cofactors. Their presence during the antiphospholipid syndrome is associated with risks of thrombosis and fetal losses. Among 5 randomly selected monoclonal antiphospholipid antibodies, all originating from a single patient suffering from this autoimmune disease, only 1 induced fetal losses when passively injected into pregnant mice. Its antiphospholipid activity was dependent on annexin A5, and its variable regions contained mainly 3 replacement mutations. To clarify the role of these mutations in the pathogenicity of the antibody, they were in vitro reverted to the germ line configuration. The resulting “germ line” antibody reacted with multiple self-antigens and only partially lost its reactivity against PLs, but it was no more dependent on annexin A5 and, more importantly, was no more pathogenic. This study illustrates that the in vivo antigen-driven maturation process of natural autoreactive B cells can be responsible for pathogenicity. (Blood. 2004;104:1711-1715)
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MESH Headings
- Adult
- Animals
- Annexins/metabolism
- Antibodies, Antiphospholipid/chemistry
- Antibodies, Antiphospholipid/genetics
- Antibodies, Antiphospholipid/immunology
- Antibodies, Antiphospholipid/toxicity
- Antibodies, Monoclonal/chemistry
- Antibodies, Monoclonal/genetics
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/toxicity
- Antigens/immunology
- Antiphospholipid Syndrome/immunology
- Autoantibodies/chemistry
- Autoantibodies/genetics
- Autoantibodies/immunology
- Autoantibodies/toxicity
- Base Sequence
- Enzyme-Linked Immunosorbent Assay
- Female
- Fetal Death/chemically induced
- Fetal Death/immunology
- Germ-Line Mutation/genetics
- Humans
- Mice
- Models, Molecular
- Molecular Sequence Data
- Pregnancy
- Protein Structure, Tertiary
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Affiliation(s)
- Patricia Lieby
- Laboratoire d'Immunopathologie, Institut de la Santé et de la Recherche Medicale, Equipe Mixte Inserum 0222, Institut d'Immunohématologie, Hôpital central, Hôpitaux Universitaires de Strasbourg, 67091, France
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30
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Pasquali JL, Nehme H, Korganow AS, Martin T. Antiphospholipid antibodies: recent progresses on their origin and pathogenicity. Joint Bone Spine 2004; 71:172-4. [PMID: 15182785 DOI: 10.1016/j.jbspin.2003.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2003] [Accepted: 11/07/2003] [Indexed: 11/26/2022]
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31
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Stojanović M, Inić-Kanada A, Popović Z, Zivković I, Dimitrijević L. Changes in pools of autoantibodies and anti-bacterial antibodies in patients suffering from recurrent infections of the urinary tract and undergoing bacterial immunization treatment. Immunol Lett 2004; 94:123-33. [PMID: 15234544 DOI: 10.1016/j.imlet.2004.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2004] [Revised: 04/13/2004] [Accepted: 04/21/2004] [Indexed: 11/20/2022]
Abstract
Antibodies (Abs) (IgM, IgA, IgG and IgG subclasses) specific for several uropathogenic strains (Escherichia coli, Pseudomonas sp. and Klebsiella sp.) as well as anti-phospholipids, anti-beta2-glycoprotein I and anti-laminin antibodies were analyzed in the sera of 20 patients with long-lasting uncomplicated recurrent infections of the lower urinary tract who underwent immunization treatment with a mixture of heat-inactivated bacteria. Immunization had a dual effect: a marked prolongation of the infection-free period in more than half of tested patients (which could be related to the profiles of anti-bacterial antibodies), and the induction of a significant decrease in autoreactivity. The results obtained showed that prolonged infections resulted in a significant rise in IgG specific for phospholipids, beta2-glycoprotein I and mouse laminin. However, irrespective of the effect on urinary tract infection per se, immunization induced a noticeable decrease in reactivity toward those antigens (Ag). The most abundant autoantibodies prior to immunization treatment were of IgG2 subclass. A statistically significant decrease in phospholipid specific antibodies belonging to this subclass, and in the concentration of Y7 cross-reactive idiotope, registered only in the responder group; this indicates the significance of natural antibody pool involvement in a proper anti-bacterial immune response.
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Affiliation(s)
- Marijana Stojanović
- Institute of Immunology and Virology Torlak, Vojvode Stepe 458, 1152 Belgrade, Serbia and Montenegro
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