Ian C. M. MacLennan

Extrafollicular antibody responses

Summary:  In adaptive antibody responses, B cells are induced to grow either in follicles where they form germinal centers or in extrafollicular foci as plasmablasts. Extrafollicular growth typically occurs in the medullary cords of lymph nodes and in foci in the red pulp of the spleen. It is not a feature of secondary lymphoid tissue associated with the internal epithelia of the body. All types of naïve and memory B cells can be recruited into extrafollicular responses. These responses are associated with immunoglobulin class switching but, at the most, only low‐level hypermutation.

Antigen-driven selection of virgin and memory B cells.

This review has summarized the evidence indicating that far more B cells are produced in adult bone marrow than are required to maintain B cell numbers in the periphery. It is shown that most if not all these newly-formed B cells have the potential to become mature peripheral B cells. However, to do this they need to receive an appropriate signal in secondary lymphoid organs. Cells failing to receive such a signal die after a brief period. Two separate situations have been identified which result in recruitment of newly-formed virgin B cells into the peripheral B-cell pool: Following activation by antigen. When the peripheral B-cell pool has been depleted. It is proposed that the first of these signals requires T help and is initiated by antigen presented on interdigitating cells in extrafollicular areas of secondary lymphoid organs. This process seems to be confined to periods immediately following administration of antigen and does not continue in established immune responses to thymus-dependent antigens. It seems probable that continued B cell activation, occurring during long term antibody responses, takes place in the follicles of secondary lymphoid organs and is driven by antigen presented on follicular dendritic cells. Indirect evidence is cited which suggests that somatic mutation in rearranged immunoglobulin V-region genes occurs mainly following B-cell activation in follicles and not during primary B lymphopoiesis. It is suggested that this may involve a hypermutation process which is switched on in activated B cells in germinal centers. Evidence is presented suggesting that plasma cells generated from B cells activated early in immune responses have an average life-span of less than 3 d. However, plasma cells generated in established responses appear to have an average life-span in excess of 20 d. Later sections in the review consider how B-cell recruitment in thymus-independent antibody responses differs markedly from recruitment during thymus-dependent responses. The possible role of splenic marginal zone B cells in some thymus-independent antibody responses is discussed and the evidence indicating that SIgM + ve, IgD-ve marginal zone B cells develop as a distinct population from recirculating SIgM + ve, IgD + ve B cells is summarized.

Germinal centres in T-cell-dependent antibody responses

For more than a century follicles have been recognized as a site of intense cell proliferation and cell death. At last the significance of this activity is beginning to emerge: antigen-driven B-cell proliferation, somatic mutation, positive and negative selection, and memory and plasma cell development all appear to take place within the follicle.

The changing preference of T and B cells for partners as T-dependent antibody responses develop

Summary: Recirculating virgin CD4+ T cells spend their life migrating between the T zones of secondary lymphoid tissues where they screen the surface of interdigitating dendritic cells. T‐cell priming starts when processed of interdigitating dendritic cells. T‐cell priming starts when processed peptides or superantigen associated with class II MHC molecules are recognised. Those primed T cells that remain within the lymphoid tissue move of the outer T zone, where they interact with B cells that have taken up and processed antigen. Cognate interaction between these cells initiates immunoglobulin (Ig) class swith‐recombination and proliferation of both B and T cells; much of this growth occurs outside the T zones. B cells both B and T cells; much of this growth occurs outside the T zones. B cells migrate to follicles. Where they form germinal centres, and to extrafollicular sites of B‐cell growth, where they differentiate into mainly short‐lived plasma cells. T cells do not move to the extrafollicular foci but to the follicles; there they proliferate and are subsequently involved in the selection of B cell that have mutated their Ig variable‐region genes. During primary antibody responses T‐cell proliferation in follicles produces many times the peak number of T cell found in that site; a substantial proportion of the CD4+ memory T‐cell pool may originate from growth in follicles.

Maturation and dispersal of B-cell clones during T cell-dependent antibody responses.

Germinal centers develop in follicles during TD antibody responses in the first 3 wk following each immunization. In primary responses to protein-based antigens, T-cell help is limiting, follicles develop towards the end of the 1st wk from immunization and the size of the follicular response in relatively small. When T-cell help is provided the primary B-cell response in follicles is much larger, B cells start to proliferate in follicles within a few hours of immunization and reach peak size 3-4 d later. Available evidence suggests that virgin B cells that colonize follicles to form germinal centers must first be activated by antigen outside follicles, probably in T zones. Memory B cells also proliferate in follicles and they can do so without first being activated outside follicles. Germinal center formation consists of an initial phase of exponential proliferation of B cells within the follicular dendritic cell network. After a single immunization the follicular response is oligoclonal and on average only 3 cells colonize each follicle. In responses to hapten-protein in rats primed previously with the carrier protein these 3 cells increase to around 10(4) cells in 3 d with a cell cycle time of about 6 h. At the end of the period of exponential growth of B blasts, the classical structure of germinal centers emerges. The B blasts become centroblasts in the dark zone of the germinal center which develops at that pole of the FDC network nearer the T zones. The centroblasts are still in rapid cell cycle but do not more than sustain their numbers. The rest of their progeny move to the heart of the FDC network where they come out of cell cycle as centrocytes. Evidence is cited which indicates that somatic mutation occurs in the Ig V-region genes of centroblasts and that centrocytes are selected on the basis of their ability to respond to antigen held on FDC. Centrocytes not receiving this antigen-dependent signal kill themselves by apoptosis. Centrocytes positively selected by interaction with antigen on FDC receive further signals which induce the cells to differentiate to become either plasma cells or memory B cells. The nature of some of these differentiation signals is described. It is shown that proliferation, selection and differentiation occur within germinal centers in distinct micro-environments.(ABSTRACT TRUNCATED AT 400 WORDS)

Follicular helper T cells

Although T cell help for B cells was described several decades ago, it was the identification of CXCR5 expression by B follicular helper T (Tfh) cells and the subsequent discovery of their dependence on BCL6 that led to the recognition of Tfh cells as an independent helper subset and accelerated the pace of discovery. More than 20 transcription factors, together with RNA-binding proteins and microRNAs, control the expression of chemotactic receptors and molecules important for the function and homeostasis of Tfh cells. Tfh cells prime B cells to initiate extrafollicular and germinal center antibody responses and are crucial for affinity maturation and maintenance of humoral memory. In addition to the roles that Tfh cells have in antimicrobial defense, in cancer, and as HIV reservoirs, regulation of these cells is critical to prevent autoimmunity. The realization that follicular T cells are heterogeneous, comprising helper and regulatory subsets, has raised questions regarding a possible division of labor in germinal center B cell selection and elimination.

Dendritic Cells, BAFF, and APRIL: Innate Players in Adaptive Antibody Responses

The first antibody produced in bacterial or viral infection results from B cell growth as plasmablasts. Dendritic cell-derived TNF-family ligands APRIL and/or BAFF enhance plasmablast survival and differentiation to plasma cells. Expression of these ligands by dendritic cells is promoted by innate immune signals that can convert subliminal B cell activation to a productive response. While this may be lifesaving in the face of infection, it can predispose to autoantibody production.

Low-level Hypermutation in T Cell–independent Germinal Centers Compared with High Mutation Rates Associated with T Cell–dependent Germinal Centers

Exceptionally germinal center formation can be induced without T cell help by polysaccharide-based antigens, but these germinal centers involute by massive B cell apoptosis at the time centrocyte selection starts. This study investigates whether B cells in germinal centers induced by the T cell–independent antigen (4-hydroxy-3-nitrophenyl)acetyl (NP) conjugated to Ficoll undergo hypermutation in their immunoglobulin V region genes. Positive controls are provided by comparing germinal centers at the same stage of development in carrier-primed mice immunized with a T cell–dependent antigen: NP protein conjugate. False positive results from background germinal centers and false negatives from non-B cells in germinal centers were avoided by transferring B cells with a transgenic B cell receptor into congenic controls not carrying the transgene. By 4 d after immunization, hypermutation was well advanced in the T cell–dependent germinal centers. By contrast, the mutation rate for T cell–independent germinal centers was low, but significantly higher than in NP-specific B cells from nonimmunized transgenic mice. Interestingly, a similar rate of mutation was seen in extrafollicular plasma cells at this stage. It is concluded that efficient activation of hypermutation depends on interaction with T cells, but some hypermutation may be induced without such signals, even outside germinal centers.

Long-term follow-up of a prospective, double-blind, placebo-controlled randomized trial of clodronate in multiple myeloma

Oral clodronate (1600 mg/d) has been shown to significantly reduce the incidence of skeletal complications in multiple myeloma. Preliminary analysis of a double‐blind placebo‐controlled trial of this treatment indicated that clodronate might prolong survival in patients without vertebral fractures at presentation. This issue was re‐examined after further follow‐up of the patients recruited into the Medical Research Council (MRC) VIth Myeloma Study. The trial examined the effects of clodronate on the natural history of skeletal disease in multiple myeloma; 619 patients were randomized between June 1986 and May 1992 commencing 15 d after the start of ABCM [adriamycin, BCNU (carmustine), cyclophosphamide, melphalan] chemotherapy or 43 d after ABCMP (ABCM + prenisolone); 535 patients who received clodronate or placebo were included in the analysis. The presence or absence of spinal fractures was assessed centrally from spinal X‐rays; long‐bone fractures were assessed locally. With a median follow‐up of 8·6 years, there was no overall significant difference in survival between the two treatment groups (O/E, χ2 = 0·78, P = 0·38). Among the subgroup of 153 patients with no skeletal fractures at presentation there was a significant survival advantage (O/E, χ2 = 7·52, P = 0·006) in favour of the 73 patients receiving clodronate, with median survivals being, respectively, 59 months (95% CI 43–71 months) and 37 months (95% CI 31–52 months), and 5‐year survivals being 46% and 35%. The original analysis of this study shows that there is a benefit in taking 1600 mg clodronate daily for patients with myelomatosis to prevent the development of new skeletal disease. Bearing in mind the limitations of subgroup analysis, the present study indicates that treatment may prolong survival in patients without overt skeletal disease at diagnosis. These observations, however, require confirmation in prospective clinical trials.

Dendritic Cells and Monocyte/Macrophages That Create the IL-6/APRIL-Rich Lymph Node Microenvironments Where Plasmablasts Mature

IL-6 and APRIL influence the growth, differentiation, and survival of normal and neoplastic Ab-forming cells (AFC). In this study, we identify two subsets of myeloid cells that associate with the AFC and are the main producers of these factors during a T-dependent Ab response to alum-precipitated protein in mouse lymph nodes. First CD11c+CD8α− dendritic cells located in the perivascular area of the T zone provide about half of the IL-6 mRNA produced in the node together with significant amounts of APRIL mRNA. The number of these cells increases during the response, at least in part due to local proliferation. The second subset comprises Gr1+CD11b+F4/80+ monocyte/macrophages. These colonize the medullary cords during the response and are the other main IL-6 mRNA producers and the greatest source of APRIL mRNA. This medullary cord monocyte/macrophage subset results in local increase of APRIL mRNA that mirrors the polarity of CXCL12 expression in the node. The distribution of these myeloid cell subsets correlates with a gradient of AFC maturation assessed by progressive loss of Ki67 as AFC pass from the B cell follicle along the perivascular areas to the medullary cords.