Ana V. Marin

Human plasma C3 is essential for the development of memory B, but not T, lymphocytes

To the Editor: Primary C3 deficiency is an extremely rare autosomalrecessive disease, with fewer than 50 families described worldwide. Plasma and intracellular C3 are considered B-cell receptor (BCR) and T-cell receptor (TCR) costimulators, respectively, but their contribution to lymphocyte biology remains obscure, particularly in humans. Reduced plasma C3 can be caused not only by primary C3 deficiency, due to loss-of-function C3 mutations, but also by secondary C3 deficiency or C3 consumption, due to gain-of-function C3 mutations or due to mutations in C3 regulators such as complement Factor I (CFI). We reasoned that comparing Band T-cell differentiation and function in primary and secondary plasma C3 deficiency might help to understand the role of plasma and intracellular C3 in adaptive immunity. We report the immunological features of lymphocytes from 9 individuals with low plasma C3 belonging to 6 families, with mutations causing primary or secondary C3 deficiency and, in some cases, chronic kidney disease stages 1 to 3 (see Fig E1,A, and Tables E1 and E3 in this article’s Online Repository at www.jacionline.org).

Complement in basic processes of the cell

The complement system is reemerging in the last few years not only as key element of innate immunity against pathogens, but also as a main regulator of local adaptive responses, affecting dendritic cells as well as T and B lymphocytes. We review data showing that leucocytes are capable of significant autocrine synthesis of complement proteins, and express a large range of complement receptors, which in turn regulate their differentiation and effector functions while cross talking with other innate receptors such as Toll-like receptors. Other unconventional roles of complement proteins are reviewed, including their impact in non-leukocytes and their intracellular cleavage by vesicular proteases, which generate critical cues required for T cell function. Thus, leucocytes are very much aware of complement-derived information, both extracellular and intracellular, to elaborate their responses, offering rich avenues for therapeutic intervention and new hypothesis for conserved major histocompatibility complex complotypes.

Crystal Structure of Glyceraldehyde-3-Phosphate Dehydrogenase from the Gram-Positive Bacterial Pathogen A. vaginae, an Immunoevasive Factor that Interacts with the Human C5a Anaphylatoxin

The Gram-positive anaerobic human pathogenic bacterium Atopobium vaginae causes most diagnosed cases of bacterial vaginosis as well as opportunistic infections in immunocompromised patients. In addition to its well-established role in carbohydrate metabolism, D-glyceraldehyde-3-phosphate dehydrogenase (GAPDH) from Streptococcus pyogenes and S. pneumoniae have been reported to act as extracellular virulence factors during streptococcal infections. Here, we report the crystal structure of GAPDH from A. vaginae (AvGAPDH) at 2.19 Å resolution. The refined model has a crystallographic Rfree of 22.6%. AvGAPDH is a homotetramer wherein each subunit is bound to a nicotinamide adenine dinucleotide (NAD+) molecule. The AvGAPDH enzyme fulfills essential glycolytic as well as moonlight (non-glycolytic) functions, both of which might be targets of chemotherapeutic intervention. We report that AvGAPDH interacts in vitro with the human C5a anaphylatoxin and inhibits C5a-specific granulocyte chemotaxis, thereby suggesting the participation of AvGAPDH in complement-targeted immunoevasion in a context of infection. The availability of high-quality structures of AvGAPDH and other homologous virulence factors from Gram-positive pathogens is critical for drug discovery programs. In this study, sequence and structural differences between AvGAPDH and related bacterial and eukaryotic GAPDH enzymes are reported in an effort to understand how to subvert the immunoevasive properties of GAPDH and evaluate the potential of AvGAPDH as a druggable target.

γδ T Lymphocytes in the Diagnosis of Human T Cell Receptor Immunodeficiencies.

Human T cell receptor (TCR) immunodeficiencies (TCRID) are rare autosomal recessive disorders caused by mutations affecting TCR, CD3, or CD247 chains, which share developmental, functional, and TCR expression defects (1). Their rapid diagnosis is fundamental for patient survival and early hematopoietic stem cell transplantation. Here, we propose that studying γδ T cells, which are often neglected, can be helpful for a timely diagnosis. We thus offer a diagnostic flowchart and some lab tricks based on published cases.

New human combined immunodeficiency caused by interferon regulatory factor 4 (IRF4) deficiency inherited by uniparental isodisomy

BACKGROUND Interferon regulatory factor 4 (IRF4) is a fundamental transcription factor in adaptive and innate immunity, due to its key role in the differentiation and functional specialization of lymphoid and myeloid lineage cells. In mouse models, IRF4 participates in bone marrow central tolerance, naïve B cell activation, germinal centre formation, plasma cell differentiation, immunoglobulin secretion, T helper subset differentiation, macrophage polarization, and dendritic cell differentiation, among other processes. OBJECTIVE To describe the first case of autosomal recessive human IRF4 deficiency. METHODS Clinical, histological, immunophenotypic and genotypic features of a patient with an autosomal recessive complete IRF4 deficiency are described. RESULTS We report the first case of autosomal recessive complete IRF4 deficiency in a 5-month-old Spanish girl caused by an uncommon mechanism for monogenic diseases, a maternal isodisomy of chromosome 6. The girl was homozygous for a maternal splicing mutation that abolished IRF4 expression and exhibited severe immunological as well as non-immunological abnormalities. Major clinical manifestations were severe dermatitis, gastro-intestinal and respiratory infections, failure to thrive, fever of unknown origin, hyperthyrotropinaemia, and severe fast hypoglycaemia. The immunological findings recapitulate many of the features observed in mouse models, including combined immunodeficiency with reduced total memory B and T cells, alteration of the κ/λ light chain ratio in immature B cells, absence of germinal centres in lymph nodes, absence of plasma cells and agammaglobulinaemia. Macrophage and T helper cell differentiation were also impaired. The patient died at 20 months of age of acute multiorgan failure after haematopoietic stem cell transplant. CONCLUSIONS This case demonstrates the relevance of IRF4 in the human immune system previously only inferred from mouse and cell models and expands our knowledge of the complexity of genetic mechanisms that lead to the appearance of primary immunodeficiencies.

Primary T-cell immunodeficiency with functional revertant somatic mosaicism in CD247

To the Editor: T lymphocytes detect antigens with the T-cell receptor (TCR) composed of a variable heterodimer (either ab or gd), 2 invariant heterodimers (CD3gε and CD3dε), and an invariant homodimer (CD247 or zz). Because of the crucial role of TCR signaling in thymic selection, mutations in TCR, CD3, or CD247 selectively impair T-cell development, albeit to different degrees: deficiency of CD3d or CD3ε, but not of CD3g or CD247, causes severe T-cell lymphopenia. Their clinical outcome is also disparate, because CD3g deficiency does not require urgent transplantation. Thus, TCR immunodeficiencies display a range of phenotypes and careful differential diagnosis is essential for appropriate therapy. We describe an infant born to consanguineous parents with early-onset chronic cytomegalovirus infection, severe immunodeficiency, and extremely low surface TCR levels. Her immunologic characterization at age 11 months is summarized in Table E1 in this article’s Online Repository at www.jacionline.

Lymphocyte integration of complement cues

We address current data, views and puzzles on the emerging topic of regulation of lymphocytes by complement proteins or fragments. Such regulation is believed to take place through complement receptors (CR) and membrane complement regulators (CReg) involved in cell function or protection, respectively, including intracellular signalling. Original observations in B cells clearly support that complement cues through CR improve their performance. Other lymphocytes likely integrate complement-derived signals, as most lymphoid cells constitutively express or regulate CR and CReg upon activation. CR-induced signals, particularly by anaphylatoxins, clearly regulate lymphoid cell function. In contrast, data obtained by CReg crosslinking using antibodies are not always confirmed in human congenital deficiencies or knock-out mice, casting doubts on their physiological relevance. Unsurprisingly, human and mouse complement systems are not completely homologous, adding further complexity to our still fragmentary understanding of complement-lymphocyte interactions.