An aberrant NOTCH2-BCR signaling axis in B cells from patients with chronic GVHD

JC Poe, W Jia, H Su, S Anand, JJ Rose… - Blood, The Journal …, 2017 - ashpublications.org
JC Poe, W Jia, H Su, S Anand, JJ Rose, PV Tata, AN Suthers, CD Jones, PF Kuan
Blood, The Journal of the American Society of Hematology, 2017ashpublications.org
Abstract B-cell receptor (BCR)-activated B cells contribute to pathogenesis in chronic graft-
versus-host disease (cGVHD), a condition manifested by both B-cell autoreactivity and
immune deficiency. We hypothesized that constitutive BCR activation precluded functional B-
cell maturation in cGVHD. To address this, we examined BCR-NOTCH2 synergy because
NOTCH has been shown to increase BCR responsiveness in normal mouse B cells. We
conducted ex vivo activation and signaling assays of 30 primary samples from …
Abstract
B-cell receptor (BCR)-activated B cells contribute to pathogenesis in chronic graft-versus-host disease (cGVHD), a condition manifested by both B-cell autoreactivity and immune deficiency. We hypothesized that constitutive BCR activation precluded functional B-cell maturation in cGVHD. To address this, we examined BCR-NOTCH2 synergy because NOTCH has been shown to increase BCR responsiveness in normal mouse B cells. We conducted ex vivo activation and signaling assays of 30 primary samples from hematopoietic stem cell transplantation patients with and without cGVHD. Consistent with a molecular link between pathways, we found that BCR-NOTCH activation significantly increased the proximal BCR adapter protein BLNK. BCR-NOTCH activation also enabled persistent NOTCH2 surface expression, suggesting a positive feedback loop. Specific NOTCH2 blockade eliminated NOTCH-BCR activation and significantly altered NOTCH downstream targets and B-cell maturation/effector molecules. Examination of the molecular underpinnings of this “NOTCH2-BCR axis” in cGVHD revealed imbalanced expression of the transcription factors IRF4 and IRF8, each critical to B-cell differentiation and fate. All-trans retinoic acid (ATRA) increased IRF4 expression, restored the IRF4-to-IRF8 ratio, abrogated BCR-NOTCH hyperactivation, and reduced NOTCH2 expression in cGVHD B cells without compromising viability. ATRA-treated cGVHD B cells had elevated TLR9 and PAX5, but not BLIMP1 (a gene-expression pattern associated with mature follicular B cells) and also attained increased cytosine guanine dinucleotide responsiveness. Together, we reveal a mechanistic link between NOTCH2 activation and robust BCR responses to otherwise suboptimal amounts of surrogate antigen. Our findings suggest that peripheral B cells in cGVHD patients can be pharmacologically directed from hyperactivation toward maturity.
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