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Address correspondence to Eric Meffre, The Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021. Phone: (212) 774-2347; Fax: (212) 717-1192; email: meffree{at}hss.edu
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Key Words: XLA • Bruton's tyrosine kinase • B lymphocytes • tolerance • autoantibody
Defects in BCR signaling have been reported in B cells from immunodeficient patients with common variable immunodeficiency who frequently develop autoimmunity, suggesting that BCR signaling may play an important role in counterselecting self-reactive B cells (11). To investigate the role of BCR signaling in the regulation of autoreactive B cells in humans, we analyzed tolerance in B cells from X-linked agammaglobulinemia (XLA) patients. XLA or Bruton's disease is characterized by a severe decrease of peripheral B cells and serum Ig (12, 13). Genetic studies in humans led to the identification of the defective gene, named Bruton's tyrosine kinase (BTK) gene, which encodes a cytoplasmic tyrosine kinase that plays an essential role in mediating BCR signaling (14, 15). Although B cell differentiation is severely affected at the pro- to pre-B transition, a few B cells develop and migrate to the periphery where they fail to accumulate (12, 16, 17). XLA has a more severe phenotype in humans than murine Xid, which results from loss of function of the murine btk gene (18). In btk–/– mice, peripheral B cells are observed but responses to T-independent antigen (type II) are impaired, whereas responses to T-dependent antigens remain normal (19). Therefore, mouse models for Btk deficiency cannot be extrapolated to humans. We report that in humans, central B cell tolerance checkpoints are abrogated in the absence of Btk.
Single Cell Sorting.
cDNA, RT-PCR, Antibody Production, and Purification.
ELISAs and Immunofluorescence Assays.
Statistical Analysis.
Online Supplemental Material.
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In humans, Ig gene recombination produces large numbers of self-reactive antibodies or B cell receptors (BCRs; reference 1). Most of the polyreactive antibodies and antinuclear antibodies (ANAs) are removed from the repertoire during B cell development, thereby ensuring self-tolerance (1). In mice, three mechanisms account for the silencing of newly arising autoreactive B cells: deletion, anergy, and receptor editing (2–5). These tolerance mechanisms are triggered and regulated by antigen binding to self-reactive BCRs. For example, transgenic and knockout mouse experiments have shown that BCR signaling thresholds are essential in B cell tolerance (6). Changes in tuning functions of the BCR coreceptors such as CD19 or CD22 and PD-1 and their associated signaling molecules Lyn and SHIP all impact on the tolerance response (7–10). Much less is known about the mechanisms that regulate B cell tolerance in humans.
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Patients.
Patients 1 and 2 are adult first cousins who suffer from a mutation in exon 11 of the BTK gene consisting of an 18-bp insertion (XLA-Ins) resulting from the duplication of neighboring DNA. Patients 3 and 4 are adolescent and preadolescent brothers who show an adenosine to cytidine substitution in codon 117 that results in a proline instead of the wild-type threonine in the pleckstrin homology domain of Btk (XLA-T117P). All patients showed similarly decreased levels of peripheral B cells that were mostly CD19+ CD10+ IgM+ CD27– new emigrant B cells. Control healthy donors were a 23-yr-old female (JH) and a 31-yr-old male (PE). All samples were collected after signed informed consent in accordance with IRB-reviewed protocols.
Peripheral B cells were purified from the blood of XLA patients and from the blood of two nonrelated healthy donors by negative selection using the RosetteSep procedure (StemCell Technologies, Inc.). Enriched B cells were stained with FITC anti–human CD27, PE anti–human CD10, anti–human IgM-biotin, and allophycocyanin anti-CD19 (BD Biosciences and Becton Dickinson). Biotinylated antibodies were revealed using Streptavidin-Red613 (GIBCO BRL). Single CD19+ CD10+ IgM+ CD27– new emigrant B cells from XLA patients and control donors were sorted on a FACSVantage (Becton Dickinson) into 96-well PCR plates containing 4 µl of lysis solution (0.5x PBS containing 10 mM DTT, 8 U RNAsin [Promega], and 0.4 U 5'-3' RNase Inhibitor [Eppendorf]) and immediately frozen on dry ice. All samples were stored at –70°C.
RNA from single cells was reverse transcribed in the original 96-well plate in 12.5 µl of reactions containing 100 U Superscript II RT (GIBCO BRL) for 45 min at 37°C. RT-PCR reactions, primer sequences, cloning strategy, expression vectors, antibody expression, and purification were as described previously (1). Ig sequences were analyzed by Ig BLAST comparison with GenBank.
Antibody concentration, reactivity against specific antigens, and indirect immunofluorescence were as described previously (1). High (polyreactive ED38) and weak (mGO186) ANA-reactive and -nonreactive mGO53 and iGO13 were used as positive and negative controls in self-reactivity and polyreactivity ELISAs (1, 20).
Two-tailed p-values were calculated by the Fisher Exact Test. Bonferroni corrections were used when analyzing unpredictable D gene usage frequency by multiplying the p-value by the number of parameters. Although some data from individual patients could reach statistical significance, the frequency of self-reactive clones was calculated after pooling data from patients carrying the same BTK gene mutation. Because of the very large number of Ig gene segments, antibody repertoire analyses were performed after pooling Ig sequences from all XLA patients.
Antibody characteristics from control new emigrant, XLA-Ins, and XLA-T117P B cells are presented in Tables S1–S3. Fig. S1 shows antibody features that differ between nonreactive and polyreactive antibodies from XLA B cells. Tables S1–S3 and Fig. S1 are available at http://www.jem.org/cgi/content/full/jem.20040920/DC1.
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Peripheral B Cell Selection in XLA Patients.
BTK gene encodes a cytoplasmic tyrosine kinase that plays an essential role in BCR signaling in humans (14, 15, 21, 22). XLA patients are characterized by a severe decrease in peripheral B cells and serum Ig levels (12, 13). In line with this observation, we found that most peripheral blood B cells from XLA patients were CD19+ CD10+ IgM+ CD27– new emigrant B cells that fail to develop into CD19+ CD10– IgM+ CD27– mature naive B cells (Fig. 1; reference 23).
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genes from XLA patients had decreased J1 usage (11.5% in XLA vs. 28.5% in control new emigrant B cells; P = 0.038) and increased J5 usage (28% in XLA vs. 8.5% in control new emigrant B cells; P = 0.0086), suggesting extensive secondary V(D)J recombination on the Ig locus (Fig. 3 A). In contrast, control new emigrant B cells preferentially use J1 and J2 segments (n = 70 from four healthy donors; Fig. 3 A and Table S1). XLA B cells also showed a V gene usage biased to upstream Vs consistent with secondary recombination events (P = 0.0045; Fig. 3 B). An apparent exception to this rule was the increased V4-1 usage, the most downstream of all Vs (16.25% in XLA patient vs. 1.5% in control new emigrant B cells; P = 0.0047; Fig. 3 B; references 20 and 28). However, V4-1 rearrangements may correspond to secondary recombination events because of their inverse orientation on the Ig locus (29). IgL gene rearrangements follow an ordered process where Ig genes rearrange before Ig
genes (30). In addition to the apparent increase in Ig gene secondary recombination in XLA B cells, we also found an increase in Ig-expressing B cells (43 Ig/51 Ig in XLA vs. 70 Ig/42 Ig in control new emigrant B cells; P = 0.017). Further, Ig genes from XLA patients showed evidence of increased secondary V(D)J recombination in that there was a significant decrease of upstream J1 usage in XLA B cells (5.9% in XLA vs. 21.4% in control new emigrant B cells; P = 0.032) and a proportional increase in more downstream J usage (Fig. 4 A). When compared with control new emigrant B cells, XLA B cells showed a significant decrease in downstreamV3 family gene usage (P = 0.005) and an increase in upstream V gene usage including unusual V4, V7, V8, V9, and V10 genes (P = 0.026; Fig. 4 B). Our results are consistent with the possibility that XLA B cells suffered extensive secondary recombination on both Ig and Ig loci.
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XLA B Cell Antibodies Are Polyreactive.
Because the HEp-2 ELISA is a crude assay for self-reactivity, we tested the reactivity of 67 antibodies isolated from XLA B cells and 31 antibodies from control new emigrant B cells to single-stranded DNA, double-stranded DNA, insulin, and LPS (1, 20). In agreement with our previous reports, we found that only a small minority (9.4%) of antibodies cloned from control new emigrant B cells was polyreactive (Fig. 6; P = 0.7 when our 31 clones are compared with previously characterized new emigrant antibodies). When combined with previously characterized new emigrant antibodies, the proportion of polyreactive clones in the new emigrant B cell compartment of healthy donors averaged 8.2% (Fig. 6; reference 1). In contrast, 50 and 37.8% of antibodies expressed by XLA-ins and XLA-T117P B cells were polyreactive (P 
0.0001; Fig. 6). In addition, polyreactive antibodies from XLA B cells showed higher levels of self-reactivity than polyreactive antibodies from control new emigrant B cells (Fig. 6).
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XLA B cells show a distinct IgL repertoire characterized by increased upstream VL and downstream JL usage consistent with extensive IgL secondary recombination (39). A similar bias of the Ig repertoire can be observed in antibody sequences obtained from EBV-transformed B cells from other XLA patients (40). As a consequence of extensive secondary recombination, we found an increased proportion of transcripts. However, XLA B cells have been reported to favor Ig expression (12). This apparent discrepancy may result from different mutations of the BTK genes that would allow residual Btk signaling and the down-regulation of secondary recombination in some cases but not others. The bias in the IgL repertoire that we observed in XLA B cells may result from the negative selection of clones that expressed innocuous BCRs and did not undergo IgL secondary recombination, but failed to escape deletion in the absence of Btk. Alternatively, newly arising XLA B cells may not sense the expression of a BCR on their cell surface and may remain equivalent to pre–B cells in that they would keep recombining their IgL genes in the absence of Btk-dependent signals initiated by the BCR. In contrast, mouse Btk-deficient B cells do not show extensive IgL secondary recombination potentially because of Btk redundancy with another tyrosine kinase from the same family, Tec, in mouse but not in humans (41, 42). We previously reported that IgL secondary recombination was prominent in human Igµ–deficient pro–B cells (26). IgL gene secondary recombination appears to be a default mechanism in the absence of IgM signaling and this regulation suggests that receptor editing at the pre–B/immature B cell stage may require appropriate BCR signaling to be down-regulated (26). Developing B cells that fail to generate such a signal may remain trapped in this editing compartment when insufficient BCR density is expressed on the cell surface or when expressing self-reactive BCRs (43–46).
The mechanisms that result in the development of autoimmunity in humans remain poorly understood. XLA as well as common variable immunodeficiency patients whose B cells show defects in BCR signaling may develop autoimmune diseases, suggesting that BCR signaling may play an important role in counterselecting self-reactive B cells (11, 47). In this report, we provide the first evidence that the alteration of BCR signaling threshold in XLA patients results in the release of self-reactive B cells in the periphery. Interestingly, the alteration of TCR signaling threshold in SKG (ZAP70W163C) mice allows the release of self-reactive T cells in the periphery and the development of a rheumatoid arthritis–like disease (48). Because TCR and BCR signaling pathways share many molecules, it is likely that the alteration of the signaling ability of one or more of those molecules may result in the modification of TCR and BCR thresholds and in the release of both self-reactive T and B cells, thereby predisposing to autoimmunity.
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This work was supported by a grant from the Dana Foundation to E. Meffre.
The authors have no conflicting financial interests.
Submitted: 10 May 2004
Accepted: 26 August 2004
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