Dysregulation of B cell repertoire formation in myasthenia gravis patients revealed through deep sequencing

JA Vander Heiden, P Stathopoulos… - The Journal of …, 2017 - journals.aai.org
The Journal of Immunology, 2017journals.aai.org
Myasthenia gravis (MG) is a prototypical B cell-mediated autoimmune disease affecting 20–
50 people per 100,000. The majority of patients fall into two clinically distinguishable types
based on whether they produce autoantibodies targeting the acetylcholine receptor (AChR-
MG) or muscle specific kinase (MuSK-MG). The autoantibodies are pathogenic, but whether
their generation is associated with broader defects in the B cell repertoire is unknown. To
address this question, we performed deep sequencing of the BCR repertoire of AChR-MG …
Abstract
Myasthenia gravis (MG) is a prototypical B cell-mediated autoimmune disease affecting 20–50 people per 100,000. The majority of patients fall into two clinically distinguishable types based on whether they produce autoantibodies targeting the acetylcholine receptor (AChR-MG) or muscle specific kinase (MuSK-MG). The autoantibodies are pathogenic, but whether their generation is associated with broader defects in the B cell repertoire is unknown. To address this question, we performed deep sequencing of the BCR repertoire of AChR-MG, MuSK-MG, and healthy subjects to generate∼ 518,000 unique V H and V L sequences from sorted naive and memory B cell populations. AChR-MG and MuSK-MG subjects displayed distinct gene segment usage biases in both V H and V L sequences within the naive and memory compartments. The memory compartment of AChR-MG was further characterized by reduced positive selection of somatic mutations in the V H CDR and altered V H CDR3 physicochemical properties. The V L repertoire of MuSK-MG was specifically characterized by reduced VJ segment distance in recombined sequences, suggesting diminished V L receptor editing during B cell development. Our results identify large-scale abnormalities in both the naive and memory B cell repertoires. Particular abnormalities were unique to either AChR-MG or MuSK-MG, indicating that the repertoires reflect the distinct properties of the subtypes. These repertoire abnormalities are consistent with previously observed defects in B cell tolerance checkpoints in MG, thereby offering additional insight regarding the impact of tolerance defects on peripheral autoimmune repertoires. These collective findings point toward a deformed B cell repertoire as a fundamental component of MG.
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