Loss of anergic B cells in prediabetic and new-onset type 1 diabetic patients

MJ Smith, TA Packard, SK O'Neill, CJ Henry Dunand… - Diabetes, 2015 - Am Diabetes Assoc
MJ Smith, TA Packard, SK O'Neill, CJ Henry Dunand, M Huang, L Fitzgerald-Miller…
Diabetes, 2015Am Diabetes Assoc
Although dogma predicts that under normal circumstances, potentially offensive autoreactive
cells are silenced by mechanisms of immune tolerance, islet antigen–reactive B
lymphocytes are known to play a crucial role in the development of autoimmunity in type 1
diabetes (T1D). Thus, participation of these cells in T1D may reflect escape from silencing
mechanisms. Consistent with this concept, we found that in healthy subjects, high-affinity
insulin-binding B cells occur exclusively in the anergic naive IgD+, IgM− B-cell (BND) …
Although dogma predicts that under normal circumstances, potentially offensive autoreactive cells are silenced by mechanisms of immune tolerance, islet antigen–reactive B lymphocytes are known to play a crucial role in the development of autoimmunity in type 1 diabetes (T1D). Thus, participation of these cells in T1D may reflect escape from silencing mechanisms. Consistent with this concept, we found that in healthy subjects, high-affinity insulin-binding B cells occur exclusively in the anergic naive IgD+, IgM B-cell (BND) compartment. Antigen receptors expressed by these cells are polyreactive and have N-region additions, Vh usage, and charged complementarity-determining region 3 consistent with autoreactivity. Consistent with a potential early role in autoimmunity, these high-affinity insulin-binding B cells are absent from the anergic compartment of some first-degree relatives and all prediabetic and new-onset (<1 year) T1D patients tested, but return to normal levels in individuals diabetic for >1 year. Interestingly, these changes were correlated by transient loss of the entire BND compartment. These findings suggest that environmental events such as infection or injury may, by disrupting B-cell anergy, dispose individuals toward autoimmunity, the precise nature of which is specified by genetic risk factors, such as HLA alleles.
Am Diabetes Assoc