Anaïs Jiménez-Reinoso

Inherited BCL10 deficiency impairs hematopoietic and nonhematopoietic immunity

Heterotrimers composed of B cell CLL/lymphoma 10 (BCL10), mucosa-associated lymphoid tissue lymphoma translocation protein 1 (MALT1), and caspase recruitment domain-containing (CARD) family adaptors play a role in NF-κB activation and have been shown to be involved in both the innate and the adaptive arms of immunity in murine models. Moreover, individuals with inherited defects of MALT1, CARD9, and CARD11 present with immunological and clinical phenotypes. Here, we characterized a case of autosomal-recessive, complete BCL10 deficiency in a child with a broad immunodeficiency, including defects of both hematopoietic and nonhematopoietic immunity. The patient died at 3 years of age and was homozygous for a loss-of-expression, loss-of-function BCL10 mutation. The effect of BCL10 deficiency was dependent on the signaling pathway, and, for some pathways, the cell type affected. Despite the noted similarities to BCL10 deficiency in mice, including a deficient adaptive immune response, human BCL10 deficiency in this patient resulted in a number of specific features within cell populations. Treatment of the patients myeloid cells with a variety of pathogen-associated molecular pattern molecules (PAMPs) elicited a normal response; however, NF-κB-mediated fibroblast functions were dramatically impaired. The results of this study indicate that inherited BCL10 deficiency should be considered in patients with combined immunodeficiency with B cell, T cell, and fibroblast defects.

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).

The Behçet's disease-associated variant of the aminopeptidase ERAP1 shapes a low affinity HLA-B*51 peptidome by differential subpeptidome processing

A low-activity variant of endoplasmic reticulum aminopeptidase 1 (ERAP1), Hap10, is associated with the autoinflammatory disorder Behçets disease (BD) in epistasis with HLA-B*51, which is the main risk factor for this disorder. The role of Hap10 in BD pathogenesis is unknown. We sought to define the effects of Hap10 on the HLA-B*51 peptidome and to distinguish these effects from those due to HLA-B*51 polymorphisms unrelated to disease. The peptidome of the BD-associated HLA-B*51:08 subtype expressed in a Hap10-positive cell line was isolated, characterized by mass spectrometry, and compared with the HLA-B*51:01 peptidome from cells expressing more active ERAP1 allotypes. We additionally performed synthetic peptide digestions with recombinant ERAP1 variants and estimated peptide-binding affinity with standard algorithms. In the BD-associated ERAP1 context of B*51:08, longer peptides were generated; of the two major HLA-B*51 subpeptidomes with Pro-2 and Ala-2, the former one was significantly reduced, and the latter was increased and showed more ERAP1-susceptible N-terminal residues. These effects were readily explained by the low activity of Hap10 and the differential susceptibility of X–Pro and X–Ala bonds to ERAP1 trimming and together resulted in a significantly altered peptidome with lower affinity. The differences due to ERAP1 were clearly distinguished from those due to HLA-B*51 subtype polymorphism, which affected residue frequencies at internal positions of the peptide ligands. The alterations in the nature and affinity of HLA-B*51·peptide complexes probably affect T-cell and natural killer cell recognition, providing a sound basis for the joint association of ERAP1 and HLA-B*51 with BD.

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.

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.