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BAFF-Ling Autoantibodies Stefanie Sarantopoulos1 and Maureen A

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BAFF-Ling Autoantibodies Stefanie Sarantopoulos1 and Maureen A commentaries any antithrombotic approach, the diffi- important data to explain molecular con- 1998;91(12):4397–4418. 5. Ruggeri ZM, Pareti FI, Mannucci PM, Ciavarella N, culty is finding efficacy without tipping the sequences for a gain-of-function mutation Zimmerman TS. Heightened interaction between hemostatic balance to increased bleeding in vWF many years after the recognition of platelets and Factor VIII/von Willebrand factor in risk. Indeed, as a player in primary hemo- type 2B as a distinct subtype of vWD. a new subtype of von Willebrand’s disease. N Engl J stasis, the vWF/platelet GP-Ib-IX axis has, Med. 1980;302(19):1047–1051. 6. Ware J, et al. Identification of a point mutation to date, been a challenge to target without Acknowledgments in type IIB von Willebrand disease illustrating the considerable risk. The findings by Casari I would like to thank Ginell Post and K.I. regulation of von Willebrand factor affinity for the et al. suggest an antithrombotic pathway Varughese (University of Arkansas for Med- platelet membrane glycoprotein Ib-IX receptor. Proc Natl Acad Sci U S A. 1991;88(7):2946–2950. mechanistic approach that has yet to be ical Sciences) for critical comments and 7. Celikel R, Ruggeri ZM, Varughese KI. von Wille- considered. While antagonizing the ligand/ helpful discussions. brand factor conformation and adhesive function receptor interaction could be justified for is modulated by an internalized water molecule. Nat Struct Biol. 2000;7(10):881–884. interrupting primary hemostasis, a type 2B Address correspondence to: Jerry Ware, 8. Casari C, et al. von Willebrand factor mutation mimetic has potential to bind to normal University of Arkansas for Medical Sci- promotes thrombocytopathy by inhibiting integrin platelet GP-Ib-IX and alter signaling path- ences, 4301 W. Markham St., Little αIIbβ3. J Clin Invest. 2013;123(12):5071–5081. 9. Murata M, Ware J, Ruggeri ZM. Site-directed ways. Could such an approach lead to an Rock, Arkansas 72205, USA. Phone: mutagenesis of a soluble recombinant fragment of antithrombotic effect beyond just block- 501.526.6096; Fax: 501.686.8167; E-mail: platelet glycoprotein Ibα demonstrating negatively ing a ligand/receptor interaction? Could [email protected]. charged residues involved in von Willebrand factor such a strategy lead to inhibition of acti- binding. J Biol Chem. 1991;266(23):15474–15480. 1. Ruggeri ZM, Zimmerman TS. von Willebrand 10. Othman M, Lopez JA, Ware J. Platelet-type von vation pathways that mirror aspirin and/ factor and von Willebrand disease. Blood. Willebrand disease update: the disease, the mol- or be complementary? While exploring this 1987;70(4):895–904. ecule and the animal model. Expert Rev Hematol. strategy is beyond the scope of the study by 2. Ruggeri ZM, Mendolicchio GL. Adhesion 2011;4(5):475–477. mechanisms in platelet function. Circ Res. 11. Guerrero JA, et al. Visualizing the von Willebrand Casari et al., the identification of altered 2007;100(12):1673–1685. factor/glycoprotein Ib-IX axis with a platelet- signaling as a consequence of mutant 3. James PD, Lillicrap D. The molecular characteriza- type von Willebrand disease mutation. Blood. vWF binding to platelets suggests such an tion of von Willebrand disease: good in parts. Br J 2009;114(27):5541–5546. Haematol. 2013;161(2):166–176. 12. Huizinga EG, et al. Structures of glycoprotein Ibα approach might be feasible. Casari and col- 4. Lopez JA, Andrews RK, Afshar-Kharghan V, and its complex with von Willebrand factor A1 leagues are to be commended for providing Berndt MC. Bernard-Soulier syndrome. Blood. domain. Science. 2002;297(5584):1176–1179. BAFF-ling autoantibodies Stefanie Sarantopoulos1 and Maureen A. Su2 1Department of Medicine, Division of Hematological Malignancies and Cellular Therapy, School of Medicine, Duke University, Durham, North Carolina, USA. 2Department of Pediatrics, Department of Microbiology and Immunology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. There is emerging evidence that autoantibodies directed against cytokines kidneys. Autoantibodies against nuclear modulate the severity of autoimmune disease. Identification of cytoki- antigens are important in disease initia- ne-targeted autoantibodies in patients can be informative for diagnosis tion, directly mediating organ injury via and predicting clinical outcome. In this issue of the JCI, Price and col- complement-mediated cascades and other leagues used a multiplex protein microarray to identify autoantibodies inflammatory mechanisms. in serum from SLE patients. They found autoantibodies directed against Interestingly, cytokines have now been the B cell–activating factor (BAFF) were associated with greater disease described as autoantibody targets in a severity. This study highlights the contribution of cytokine-directed auto- number of disease settings, resulting in antibodies in disease and describes a valuable tool for identifying autoan- a range of clinical manifestations (1). In tibodies against serum antigens. many of these diseases, autoantibodies are produced against cytokines that are Cytokine-targeting autoantibodies test for autoantibodies against insulin and important in host defense and thus lead in disease other pancreas-specific antigens to differ- to functional immunodeficiency. Autoim- Spontaneous autoantibody production is entiate autoimmune (type 1) diabetes from mune polyendocrinopathy syndrome type a hallmark of many autoimmune diseases, other types of diabetes. In addition to serv- 1 (APS-1), for example, is characterized by and these disease-specific autoantibodies ing as markers for autoimmunity, autoan- multiorgan autoimmunity and mucocu- are often useful in affirming a clinical auto- tibodies can play a central role in disease taneous candidiasis (2). For many years, immune diagnosis. For instance, clinicians pathogenesis. Strong evidence exists that the predisposition to candidiasis, which autoantibodies are important in devel- seemed to reflect a state of immunodefi- opment of SLE, a systemic autoimmune ciency, appeared to be an inconsistent find- Conflict of interest: The authors have declared that no conflict of interest exists. disease characterized by immune-medi- ing among the multiple autoimmune man- Citation for this article: J Clin Invest. 2013; ated injury that affects a large number of ifestations in APS-1. A possible explanation 123(12):5006–5008. doi:10.1172/JCI73166. tissues, including brain, blood vessels, and for this seemingly irregular finding was 5006 The Journal of Clinical Investigation http://www.jci.org Volume 123 Number 12 December 2013 commentaries neutralization of IFN-α may alleviate SLE severity, although further work is required to establish causation. In this issue, Price et al. identified autoantibodies against the unique TNF family member B cell– activating factor (BAFF; also called BLys) in SLE patient serum and demonstrated that these autoantibodies neutralize BAFF activity in cell culture systems (11). Fur- thermore, the authors reported a positive correlation between the presence of neu- tralizing autoantibodies against BAFF and features associated with a more severe SLE disease profile (11). At first glance, this finding is some- what surprising, since studies in mice and humans have shown that BAFF is crucial for SLE pathogenesis. BAFF is a B cell sur- vival factor that is primarily produced by innate immune cells such as monocytes, dendritic cells, neutrophils, and stromal cells, including central nervous system astrocytes and airway epithelia (12). BAFF is produced as a membrane-bound protein that is released following protease cleav- age. SLE patients have high circulating lev- els of BAFF, which correlate with increased autoantibody titers and SLE activity (13, 14). Additionally, the amount of available soluble BAFF (sBAFF) is a pivotal deter- minant of B cell homeostasis, and BAFF Figure 1 Model for how autoantibodies against BAFF may exacerbate SLE. Excess sBAFF promotes overexpression in mice leads to an auto- outgrowth of autoreactive B cells, which include BAFF-specific B cells (i). sBAFF (red) may then immune disease reminiscent of SLE (15, bind to BAFF-specific B cell receptors (BCR) on B cells and promote production of autoantibod- 16). Together, these findings predict that ies against BAFF (ii). BAFF-IgG immune complexes may be bound by monocyte Fc receptors neutralization of BAFF by autoantibodies (FcR), which stimulate cleavage of membrane BAFF (mBAFF; orange) and further production would be associated with milder disease, of sBAFF (iii). In addition, autoantibodies against BAFF may neutralize ΔBAFF (yellow), a nat- rather than severe disease, as observed in ural regulator of BAFF (iv). Excess sBAFF may then promote autoimmunity and provide further this study. One caveat to consider is that antigen targets for BAFF-specific B cells. Price et al. found this correlation in a small cohort of SLE patients (11); there- fore, these results will require validation in recently revealed by reports of neutralizing and staphylococcal skin infections associ- larger, independent SLE cohorts. It is pos- autoantibodies against IL-17A and related ated with autoantibodies against IL-6 (9). sible that these BAFF-targeted antibodies cytokines in APS-1 patients (3, 4). The Cytokine-targeting autoantibodies are are merely a reflection of an autoimmune activity of IL-17 is essential for host defense proving to be a recurring cause of immu- response to high amounts of a protein in against candidal
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