Individuals with Iga Deficiency and Common Variable Immunodeficiency Share Polymorphisms of Major Histocompatibility Complex
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Proc. Nati. Acad. Sci. USA Vol. 86, pp. 8015-8019, October 1989 Immunology Individuals with IgA deficiency and common variable immunodeficiency share polymorphisms of major histocompatibility complex class III genes (B-cell differentiation/complement component C2/complement component C4/steroid 21-hydroxylase/HLA) F. M. SCHAFFER*, J. PALERMOSt, Z. B. ZHUt, B. 0. BARGER*, M. D. COOPER*§, AND J. E. VOLANAKISt¶ *Division of Developmental and Clinical Immunology, Departments of Pediatrics, Medicine, Microbiology, and Pathology, and The Comprehensive Cancer Center, tDivision of Clinical Immunology and Rheumatology, Department of Medicine, *Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294; and the §Howard Hughes Medical Institute, Birmingham, AL 35294 Contributed by M. D. Cooper, July 11, 1989 ABSTRACT IgA deficiency and common variable immu- to B-cell stage in the X chromosome-linked form of congen- nodeficiency are heritable disorders that can occur within the ital agammaglobulinemia (3, 6). same family. Both immunodeficiencies are characterized by The cause ofthe variable B-cell arrests in CVID and IgA-D arrests in B-cell differentiation that vary in the extent of the is unknown. B cells from individuals with CVID are capable immunoglobulin isotypes involved. A high frequency of major of plasma-cell differentiation, as can be demonstrated after histocompatibility complex supratypes associated with a null their infection with Epstein-Barr virus (7). Because T cells allele of the gene encoding the C4A isotype of complement are needed to help B cells respond with antibody production component C4 has been observed in IgA-deficient individuals. to most antigens, a defect of the T cells has long been In search of a genetic linkage between the two immunodefi- suspected in CVID and IgA-D (8-10). Although T cells are ciencies, we examined the major histocompatibility complex usually present in normal numbers, analysis of affected (MHC) class HI genes encoding complement components C2, individuals sometimes suggests either a deficit in helper C4A, and C4B and steroid 21-hydroxylase in addition to the T-cell function or excessive suppressor activity (8-10). Other HLA serotypes in individuals with either common variable studies suggest that T cells from most of these patients are immunodeficiency or IgA deficiency. Twelve of 19 patients with capable of providing all the necessary elements for B-cell common variable immunodeficiency (63%, P < 0.001) and 9 of growth and differentiation (11, 12). 16 patients with IgA deficiency (56%, P < 0.01) had rare C2 While CVID and IgA-D may represent multifactorial dis- alleles and/or C4A and 21-hydroxylase A deletions, whereas eases, susceptibility appears to be heritable, with family these gene features were seen in only 5 of34 healthy individuals studies suggesting an autosomal recessive mode of inheri- (15%) in the control group. Nine of 11 patients with C4A tance (13, 14). CVID and IgA-D have also been observed in deletion had an HLA haplotype consistent with the MHC immediate relatives (13), suggesting a common gene defect. supratype HLA-Al, Cw7, B8, C4AQO, C4B1, BfS, DR3 pre- In search of a shared genetic basis for CVID and IgA-D, we viously found to be associated with IgA deficiency. The data have turned our attention to the major histocompatibility support the hypothesis that common variable immunodefi- complex (MHC) of genes for two main reasons. First, this ciency and IgA deficiency are related disorders, susceptibility region of chromosome 6 encodes a variety of molecules to which is determined by a gene(s) within or near the MHC involved in antigen presentation and T-cell/B-cell interac- class III gene region on chromosome 6. tions (15). Second, studies of individuals with IgA-D have revealed a relatively high incidence of certain HLA haplo- Common variable immunodeficiency (CVID) and selective types (16, 17) and MHC supratypes, the most consistent IgA deficiency (IgA-D) are diagnostic classifications applied feature of which is the presence of null alleles of the gene to groups of immunodeficient individuals exhibiting de- encoding the A isotype of complement component C4 (C4A) creased levels either ofmultiple immunoglobulin classes or of (14). Our present studies reveal that individuals with CVID IgA alone (1). These are not homogeneous entities, but rather and IgA-D have in common a very high incidence of partic- represent opposite ends of a spectrum of immunoglobulin ular restriction fragment length polymorphisms (RFLPs) or deficiencies. Individuals diagnosed as having CVID are fre- deletions of MHC class III genes. quently panhypogammaglobulinemic but may produce sub- stantial levels of IgM. Conversely, individuals with IgA-D may also be deficient in one or more IgG subclasses (2). MATERIALS AND METHODS CVID, typically manifested by recurrent bacterial infections, Participants. All individuals in the is usually recognized in adolescents or young adults and thus Study participating is sometimes called the late-onset form of hypogammaglob- study were Caucasian. Thirty-four healthy individuals (17 ulinemia. In most individuals with CVID, B cells are pro- male and 17 female) randomly selected for study had normal duced in normal numbers but they fail to undergo differen- serum immunoglobulin levels. The 19 CVID patients (12 tiation into antibody-secreting plasma cells (3, 4). Similarly, female and 7 male) and 16 patients with selective IgA-D (6 individuals with IgA-D have normal numbers of IgA-bearing female and 10 male) were selected from a group of immuno- B cells, but these are relatively immature and fail to undergo deficient patients followed in our immunology clinic. In- terminal differentiation into IgA-secreting plasma cells (5). formed consent was obtained from all participants. The arrests in B-cell differentiation seen in CVID and IgA-D are thus similar and contrast with the arrest seen at the pre-B- Abbreviations: MHC, major histocompatibility complex; C2, second component of complement; C4, fourth component of complement; 21-OHase, steroid 21-hydroxylase; IgA-D, IgA deficiency; CVID, The publication costs of this article were defrayed in part by page charge common variable immunodeficiency; RFLP, restriction fragment payment. This article must therefore be hereby marked "advertisement" length polymorphism. in accordance with 18 U.S.C. §1734 solely to indicate this fact. $To whom reprint requests should be addressed. 8015 Downloaded by guest on September 30, 2021 8016 Immunology: Schaffer et al. Proc. Natl. Acad. Sci. USA 86 (1989) 0 5 10 15 20 kb 5' 3'5' C2 }-EU A 6.6* Bam Hi 3.45-32* I 4.4 2.2 1 Sst I 1 2.75-2.5*1 C H 6.6 *----H B 1 2.1 1 4.5 J Taq I FIG. 1. Schematic representation ofthe C2 gene RFLPs. kb, Kilobases. A partial restriction map ofthe C2 gene (23) is shown with the relative positions and sizes ofpolymorphic fragments indicated by asterisks. Probes A and C are the 5' 2-kbp and 3' 1-kbp EcoRI fragments, respectively, of a full-length cDNA for C2 (22). Probe B is a 300-bp DNA fragment derived from the 5' region of a C2 genomic clone (23). Probe A detects two polymorphisms: (i) A BamHI multiallelic polymorphism with five classes of size variants exhibiting fragments of 3.45, 3.40, 3.35, 3.30, and 3.20 kbp. This polymorphism is also detected by using Sst I-digested DNA and probe B. The Sst I polymorphic fragments have corresponding lengths of 2.75, 2.70, 2.65, 2.60, and 2.50 kbp. (ii) A second BamHI polymorphism characterized by the loss of a 4.4-kbp fragment and the appearance of a 6.6-kbp fragment. Probe C detects a Taq I polymorphism mapping to the 3' end of the C2 gene and characterized by the loss of a 4.5-kbp fragment and the appearance of a 6.6-kbp fragment. Immunofluorescence Studies. Mononuclear cells were iso- B gene (24). Both were gifts from David Chaplin (Washington lated from heparinized blood samples by centrifugation over University, Saint Louis). The purified DNA probes were Ficoll/Hypaque density gradients. B and T lymphocytes radiolabeled with [32P]dCTP (Amersham) by the random were enumerated by indirect immunofluorescence using primer method (25). monoclonal antibodies and a FACS Scan II flow cytometry HLA Typing. Typing antisera obtained from the National unit (Beckton Dickinson). The anti-B-cell monoclonal anti- Institutes ofHealth, local screening, and commercial sources bodies were specific for cell surface IgM, IgD, IgA, HLA- were utilized for HLA-A, B, DQ, and DR typing by the DR, HLA-DQ, and the HB-2 antigen (18). The T-cell mono- microdroplet lymphocytotoxicity test (26). clonal antibodies were against the CD3, CD4, and CD8 Statistical Analysis. Differences in the frequency of study antigens. Serum immunoglobulin concentrations were deter- parameters between the control and patient populations were mined by rate nephelometry. assessed by the x2 test with correction for continuity, and Southern Blot Analysis. Genomic DNA was extracted from differences between mean values were assessed by the non- the buffy coat fraction of blood samples collected in EDTA paired Student t test. (19). Ten micrograms of genomic DNA was digested with restriction endonucleases (Taq I, BamHI, HindIII, or Sst I) under conditions suggested by the suppliers. DNA restriction RESULTS fragments were separated by electrophoresis through 0.8% Study Population. Immunological parameters of the 19 agarose gels. Phage A DNA digested with HindIII or EcoRI individuals with CVID and 16 individuals with IgA-D are plus HindIII was used as molecular size markers. After summarized in Table 1. None of the patients was lym- electrophoresis, DNA fragments were transferred to nitro- phopenic. All had normal percentages of T cells as indicated cellulose membranes by the method of Southern (20). Pre- by values for the CD3+, CD4+, and CD8+ cells, although the hybridization and hybridization of the membranes was car- CD4/CD8 ratio was lower in the CVID group.