The loss of IgM memory B cells correlates with clinical disease in common variable immunodeficiency
The loss of IgM memory B cells correlates with clinical disease in common variable immunodeficiency
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DOI：
10.1016/j.jaci.2004.10.048
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发表时间：
2005-02-01
影响因子：
14.2
通讯作者：
Quinti, I
中科院分区：
文献类型：
--
作者：
Carsetti, R;Rosado, MM;Quinti, I
背景资料：在普通变异型免疫缺陷（CVID）患者中，由包囊细菌引起的反复下呼吸道感染可能导致永久性器官损伤。尽管存在严重的低丙种球蛋白血症，但有些患者不会发生细菌性肺炎。我们已经证明IgM记忆B细胞和天然抗体在防御包裹细菌中起重要作用。目的：在这项研究中，我们提出了一个问题，即是否可以用IgM记忆B细胞和抗肺炎球菌多糖的存在来解释严重低丙种球蛋白血症患者但呼吸道感染频率没有增加的明显矛盾方法：我们检测了26例CVID患者（第1组）和22例从未患过肺炎且无肺部病变的CVID患者（第2组）的记忆B细胞频率和抗PnPS IgM抗体水平。另外6例患者有复发性肺炎的临床病史，计算机断层扫描时无肺部异常。结果如下：结论：IgM记忆B细胞和抗PnPS IgM抗体对CVID患者的细菌性肺炎有保护作用。对这2个参数的评价可区分由包囊细菌引起的复发性感染的低风险或高风险以及支气管扩张的低风险或高风险。在诊断时识别高风险个体可能有助于规划更有效的治疗策略并防止永久性器官损伤。
Background: Recurrent lower respiratory tract infections caused by encapsulated bacteria might cause permanent organ damage in patients with common variable immunodeficiency (CVID). Despite the profound hypogammaglobulinemia, some patients do not experience bacterial pneumonia. We have shown that IgM memory B cells and natural antibodies play an important role in the defense against encapsulated bacteria.Objective: In this study we addressed the question of whether the apparent paradox of patients with severe hypogammaglobulinemia but no increased frequency of respiratory infections can be explained by the presence of IgM memory B cells and anti-pneumococcal polysaccharide (anti-PnPS) IgM.Methods: We measured the frequency of memory B cells and the levels of anti-PnPS IgM antibodies in 26 patients with CVID with recurrent bacterial pneumonia and bronchiectasis (group 1) and 22 who never had pneumonia and showed no lung lesions (group 2). An additional 6 patients had a clinical history of recurrent pneumonia without lung abnormalities at computed tomographic scanning. Results: Patients of group 1 lacked IgM memory B cells and failed to produce anti-PnPS IgM antibodies, and those of group 2 had a normal frequency of IgM memory B cells and produced anti-PnPS IgM antibodies.Conclusions: IgM memory B cells and anti-PnPS IgM antibodies protect patients with CVID from bacterial pneumonia. Evaluation of these 2 parameters discriminates patients with low or high risk of recurrent infections caused by encapsulated bacteria and low or high risk of bronchiectasis. Identification of high-risk individuals at diagnosis might help in the planning of a more effective therapeutic strategy and prevent permanent organ damage.