Up-regulation of CX3CR1 on tonsillar CD8-positive cells in patients with IgA nephropathy

Although tonsillectomy are used as therapeutic options to prevent chronic renal failure in IgA nephropathy (IgAN) patients, the relationship between IgAN and tonsils is not fully proved by basic research. Recently, circulating CX3CR1-positive cells were reportedly involved in promoting hematuria in patients with IgAN. In this study, we focused on the expression of CX3CR1 in tonsillar mononuclear cells in IgAN patients. Immunohistological analysis revealed greater distribution of CX3CR1-positive cells in the inter-follicular area of tonsils in IgAN patients than in non-IgAN patients. CX3CR1-positive cells were also found in the affected renal glomerulus of IgAN patients. Flow cytometric analysis revealed the expression of CX3CR1 on tonsillar CD8-positive cells to be significantly higher in IgAN patients. CpG-oligodeoxynucleotides enhanced the expression in IgAN patients. The chemotactic response of tonsillar mononuclear cells to fractalkine was significantly higher in IgAN patients. Expression of CX3CR1 on peripheral blood CD8-positive cells in IgAN patients was significantly higher, and decreased after tonsillectomy, along with the disappearance of hematuria. These results suggest that hyper-immune response to microbial DNA enhanced the expression of CX3CR1 on tonsillar CD8-positive cells in IgAN patients, followed by the migration of the cells to renal lesions via blood circulation, resulting in the development of hematuria.     

Immune response of tonsillar lymphocytes to Haemophilus parainfluenzae in patients with IgA nephropathy

The pathogenesis of IgA nephropathy (IgAN) is unclear. We have previously shown glomerular deposition of Haemophilus parainfluenzae (HPI) antigens and the presence of IgA antibody against HPI antigens in patients with IgAN. We examined the immune response to HPI antigens in tonsillar lymphocytes from patients with IgAN. Lymphocytes isolated from the palatine tonsils of 13 IgAN patients and 16 patients with chronic tonsillitis but without renal disease were used as controls. We examined lymphocyte proliferation and production of IgA antibody against HPI antigens by measuring thymidine uptake and IgA antibody in culture supernatants after lymphocyte incubation with HPI antigens. Patients with IgAN showed a significantly higher stimulation index to HPI antigens (thymidine incorporation in tonsillar lymphocytes with HPI/thymidine incorporation in unstimulated tonsillar lymphocytes) than controls (P < 0.002). Lymphocytes from patients with IgAN also showed a significantly higher level of IgA antibody and IgA1 antibody against HPI antigens in culture supernatants than lymphocytes from controls (P = 0.0002 and P = 0.004, respectively). Our results suggest that HPI antigens stimulate tonsillar T and B lymphocytes in patients with IgAN and that an immune response to HPI antigens may play a role in the pathogenesis of this disease in some cases.     

Age-related differences in human palatine tonsillar B cell subsets and immunoglobulin isotypes

The tonsils provide defense of the upper aerodigestive tract against pathogens. Although long known to undergo functional changes with age, the precise changes occurring within tonsillar B cell populations remain undefined. In the present study, we investigated age-related changes in palatine tonsillar B cell subsets and immunoglobulin (Ig) isotypes. Palatine tonsils were obtained from forty-two tonsillectomy patients without tonsillitis who were divided into three groups: young children (4–9 years), adolescents (10–19 years), and adults (20–60 years). Tonsillar B cells were then analyzed by flow cytometry. Using expression of CD38 and IgD to define B cell subsets, we found that the frequency of germinal center (GC) B cells in the tonsils was significantly higher, and the frequency of memory B cells lower, in young children as compared to adolescents and adults. Within the GC B cell subsets, adults had a higher frequency of IgA⁺ cells and a lower frequency of IgM⁺ cells as compared to individuals in the younger age groups. Moreover, young children had a higher frequency of IgG⁺ cells in the GC B cell subsets than did individuals in the older age groups. We also observed an abundance of IgM⁺ cells among memory B cells and plasmablasts in young children and IgA⁺ cells in adults. In summary, the proportion of GC B cells in palatine tonsillar B cells decreases with age, while the proportion of memory B cells increases with age. In addition, Ig isotypes in tonsils preferentially switch from IgM to IgA as individuals age.     

Enhanced expression of L-selectin on peripheral blood lymphocytes from patients with IgA nephropathy

To investigate the homing characteristics of T and B lymphocytes which could explain the abnormal partition of IgA-producing cells in tonsils and bone marrow from patients with IgA nephropathy (IgAN), the expression of leucocyte adhesion molecules (CD11a, CD29, CD49d, CD62L, CD31) was assessed using flow cytometry on peripheral blood leucocytes from patients with biopsy-proven IgAN and controls. Higher proportions of T and B lymphocytes expressing higher amounts of L-selectin, as well as higher proportions of B cells expressing more CD31 were evidenced in IgAN patients. Conversely, serum levels of sCD62L were not different from controls, but significantly higher than serum levels in patients suffering from other renal diseases. We hypothesize that this over-expression of CD62L and CD31 may be involved in an enhanced efficiency of lymphoid cells homing to lymphoid tissues in this disease.     

The influences of α-hemolytic Streptococcus on class switching and complement activation of human tonsillar cells in IgA nephropathy

While β-hemolytic streptococcus (β-HS) infections are known to predispose patients to acute poststreptococcal glomerulonephritis, there is evidence that implicates α-hemolytic streptococcus (α-HS) in IgA nephropathy (IgAN). The alternative pathway of the complement system has also been implicated in IgAN. We aimed to explore the association between α-HS and complement activation in human tonsillar mononuclear cells (TMCs) in IgAN. In our study, α-HS induced higher IgA levels than IgG levels, while β-HS increased higher IgG levels than IgA levels with more activation-induced cytidine deaminase, in TMCs in the IgAN group. Aberrant IgA1 O-glycosylation levels were higher in IgAN patients with α-HS. C3 and C3b expression was decreased in IgAN patients, but in chronic tonsillitis control patients, the expression decreased only after stimulation with β-HS. Complement factor B and H (CFH) mRNA increased, but the CFH concentration in culture supernatants decreased with α-HS. The percentage of CD19?+?CD35?+?cells/complement receptor 1 (CR1) decreased with α-HS more than with β-HS, while CD19?+?CD21?+?cells/complement receptor 2 (CR2) increased more with β-HS than with α-HS. The component nephritis-associated plasmin receptor (NAPlr) of α-HS was not detected on tonsillar or kidney tissues in IgAN patients and was positive on cultured TMCs and mesangial cells. We concluded that α-HS induced the secretion of aberrantly O-glycosylated IgA while decreasing the levels of the inhibitory factor CFH in culture supernatants and CR1?+?B cells. These findings provide testable mechanisms that relate α-HS infection to abnormal mucosal responses involving the alternative complement pathway in IgAN.

     

CD5–Positive and CD5–Negative Rheumatoid Factor–Secreting B Cells in IgA Nephropathy,Rheumatoid Arthritis and Graves’Disease

The relative contributions of CD5⁺ and CD5^– B–cells in production of rheumatoid factors (RF) was evaluated in polyclonally activated B–cells from patients with IgA nephropathy (IgAN), rheumatoid arthritis (RA) and Graves’ disease (GD). In IgAN and RA, diseases in which RFs are believed to be involved in pathogenesis, there were 10– and 4–fold decreases respectively in CD5⁺ IgG–RF–secreting B–cells compared with controls. Furthermore, the number of CD5^– IgG–RF– and IgA–RF–secreting B–cells were increased 12– and 14–fold in IgAN and 9– and 4–fold in RA. Such abnormalities were not apparent in GD, in which RFs have not been implicated in pathogenesis. These findings are compatible with the concept of CD5⁺ RF–secreting B–cells normally acting to prevent production of potentially pathogenic RFs by CD5^– B–cells. When IgAN or RA patients’ B–cells were activated in the presence of control instead of autologous CD4⁺ cells, numbers of RF– secreting CD5^– B–cells were reduced to the levels seen with control B–cells plus control T–helper cells. Presumably lymphokine secretion profiles of T–helper cells would be important in determining whether CD5⁺ or CD5^– B–cells are activated to secrete RFs, and perhaps therapeutic manipulation of these profiles could restore normal activity of CD5⁺ B–cells in IgAN and RA.     

Increase in B-cell-activation factor (BAFF) and IFN-gamma productions by tonsillar mononuclear cells stimulated with deoxycytidyl-deoxyguanosine oligodeoxynucleotides (CpG-ODN) in patients with IgA nephropathy

IgA nephropathy (IgAN), the most common form of primary glomerulonephritis, is recognized as a tonsil-related diseases since it often gets worse after and/or during acute tonsillitis and the disease progression is often prevented by tonsillectomy. Although several reports showed an increase in IgA production of tonsillar mononuclear cells (TMCs), its mechanism has not yet been fully clarified. Recently, B-cell-activation factor (BAFF), which stimulates B-cell proliferation and immunoglobulin production, was identified. Unmethylated deoxycytidyl-deoxyguanosine oligodeoxynucleotide (CpG-ODN), which is able to mimic the immunostimulatory activity of microbial DNA, is known to be involved in the production of immunoglobulins and some cytokines. In this study, we focused on roles of BAFF and IFN-gamma in IgA production of TMCs stimulated with CpG-ODN in IgAN patients. Two-color flow cytometric analysis revealed that the intercellular expression of IFN-gamma on the T-cells freshly isolated from tonsils was significantly higher in IgAN patients than in non-IgAN patients (p=0.032). The spontaneous productions of IgA and IFN-gamma of TMCs were significantly higher in IgAN patients than in non-IgAN patients (p=0.023 and p=0.02). Under stimulation with CpG-ODN, the productions of IgA, BAFF and IFN-gamma of TMCs were significantly higher in IgAN patients than in non-IgAN patients (p=0.013, p=0.005 and p=0.039). The IgA production of TMCs stimulated by CpG-ODN was inhibited by the treatment with anti-BAFF antibody and/or anti-IFN-gamma antibody. Under stimulation with IFN-gamma, the BAFF expression on the CD1c cells and the BAFF production of TMCs were significantly higher in IgAN patients than in non-IgAN patients (p=0.004 and p=0.042). These data suggest that hyper-immune response to microbial DNA may be present in IgAN patients and may lead to hyperproduction of BAFF up-regulated by IFN-gamma, resulting in hyperproduction of IgA in IgAN patients.     

Functional Implications of Regulatory B Cells in Human IgA Nephropathy

IgA nephropathy (IgAN) diagnosis remains largely based upon immunohistologic detection of IgA‐ and IgG‐containing glomerular deposits in renal mesangial cells, and little is known about the underlying pathogenic mechanisms. This study examines the putative contribution of B cell types, including the Breg type, to IgAN pathogenesis. Twenty‐four patients with IgAN and proteinuria (Group A: <3.5 g/24 h, n = 13; Group B: >3.5 g/24 h, n = 11) and 10 healthy controls were enrolled. The frequencies of B cell subtypes in venous blood were measured by flow cytometry. Galactose‐deficient IgA1 was measurement by ELISA. Needle biopsies were analysed by histology and immunofluorescence microscopy. Correlation between clinical features and B cell subtypes, including the regulatory B (Breg) cells, and Breg cell‐derived immunomodulatory cytokine IL‐10 was assessed by Spearman's rank correlation test. IgAN patients had significantly higher frequencies of CD27⁺CD19⁺, CD38⁺CD19⁺, CD86⁺CD19⁺ and CD5⁺CD19⁺ B cells than the healthy controls, but significantly lower levels of Breg cells and intracellular expression of IL‐10 protein in the Breg subtype. Serum IgA concentration positively correlated with CD27⁺CD19⁺ B cell frequency and negatively correlated with IL‐10⁺ Breg cell frequency in IgAN patients, and the percentage of CD19⁺CD5⁺CD1d⁺ in CD19⁺ cells was negatively correlated with the level of serum Gd‐IgA1. Furthermore, the frequencies of CD19⁺CD38⁺ and CD19⁺CD86⁺ in the CD19⁺ subpopulation negatively correlated with the estimated glomerular filtration rate of IgAN patients. Several of the CD19⁺ B cell subtypes and the IL‐10⁺ Breg cells are differentially expressed in IgAN patients and may contribute to the disease pathogenesis.     

Studies on the Role of CD43 in Human B-Cell Activation and Differentiation

The monoclonal antibody (MoAb) B1B6 to human leucocyte sialoglycoprotein, CD43, induces aggregation of T cells and delivers progression signals early during activation of both T and B cells in the presence of primary activators of protein kinase C. In this report we further studied the role of CD43 in human B-cell activation and differentiation. About 5-10% of resting tonsillar B cells are CD43+. In the presence of TPA or antibodies to CDw40, the proportions of CD43+ cells drastically increased. The expression was optimal on day 3 of culture, when up to 80% and 50%, respectively, were CD43+. Whereas MoAb B1B6 together with TPA induced a three- to fivefold higher proliferative response as compared to TPA alone, antibodies to CDw40 did not synergize with MoAb B1B6 in B-cell proliferation. Tonsillar populations depleted of CD43+ B cells responded with lower proliferation to TPA alone or to TPA and B1B6 or anti-CDw40 antibodies. MoAb B1B6 did not affect the production of IgM or IgG as induced by pokeweed mitogen in the presence of autologous T cells, from either peripheral blood or tonsillar B cells. Neither did it affect the IgG production from the CD43+ BSF-2 sensitive Epstein-Barr virus-transformed lymphoblastoid cell line CESS. The results show that CD43 is upregulated on B cells during activation. Furthermore, CD43+ B cells are included in the population which responds to signals delivered by TPA, anti-CD43 or anti-CDw40 antibodies, and the proliferation of this population is not merely due to an expansion of the small population of CD43+ cells present among these cells. Moreover, the epitopes recognized by MoAb B1B6 are not involved in the differentiation of and ultimate Ig-secretion from activated B cells.     

Is IgA nephropathy induced by abnormalities of CD4CD25Treg cells in the tonsils?

IgA nephropathy (IgAN) is characterized by the accumulation of IgA deposits, predominantly in the glomerular mesangium, and represents the most common form of glomerulonephritis. Much evidence showed that tonsils were closely related to IgAN. Urinary findings were deteriorated after tonsil stimulation in patients with IgAN. Tonsillectomy can improve the urinary findings, keep stable renal function, improve mesangial proliferation, decrease IgA deposits and have a favorable effect on long-term renal survival in some IgAN patients. Recent studies indicate that CD4(+)CD25(+) regulatory T cells (Treg) are of critical importance to the maintenance of tolerance by inhibiting the activation and proliferation of autoreactive T cells. Depletion of the minor CD4(+)CD25(+)Treg cells results in the development of organ-specific autoimmunity. Autoimmune diseases can be prevented by reconstitution of the animals with CD4(+)CD25(+)Treg cells. CD4(+)CD25(+)Treg cells are regulators in almost all of the animal models of human organ-specific diseases, transplant rejection and allergic diseases. Some patients with recurrent chronic tonsillitis have not suffered from renal disease, implying that it is possible to find a balance between immunity and tolerance. Some patients, however, suffered from IgAN along with recurrent chronic tonsillitis. It could be hypothesized that a numerical and/or functional deficit of CD4(+)CD25(+)Treg cells in the tonsils of IgAN patients might trigger the development of the diseases. If the hypothesis is correct, altering CD4(+)CD25(+)Treg cell numbers and/or enhancing CD4(+)CD25(+)Treg responses might be useful in the prevention and treatment of IgAN.     

Reduced susceptibility to Fas-mediated apoptosis in B-1 cells

Elimination of activated T and B cells by Fas-dependent apoptosis may contribute to the maintenance of peripheral tolerance. CD40 ligation was recently shown to up-regulate Fas expression and enhance susceptibility to Fas-mediated apoptosis in mouse splenic B cells. In the present study, we have investigated the regulation of Fas expression and Fas-triggered apoptotis in mouse peritoneal B-1 cells. B-1 cells expressed a similar level of CD40 as that on B-2 cells, and proliferated in response to a soluble CD40 ligand (CD40L)-CD8α chimeric protein, suggesting that CD40 on B-1 cells is functional. In contrast to B-2 cells, B-1 cells expressed Fas at only low levels in response to CD40L-CD8α alone or CD40L-CD8α+interleukin-4, and were resistant to Fas-mediated apoptosis following these treatments. While Fas expression could be induced in B-1 cells to a comparable level as that in B-2 cells by cross-linking CD40L-CD8α with an anti-CD8α antibody, the sensitivity to Fas-mediated apoptosis in B-1 cells was significantly reduced compared with B2 cells. These results suggest that peritoneal B-1 cells from normal mice have a lower susceptibility to Fas-mediated apoptosis and may distinguish B-1 from B-2 cells. Similarly, B-1 cells from the peritoneal cavity and spleen of autoimmune-prone NZB mice exhibited reduced susceptibility to Fas-mediated apoptosis relative to their B-2 counterparts. NZB splenic B-1 cells, however, were more susceptible to Fas-mediated apoptosis than NZB peritoneal B-1 cells. The results presented here raise the possibility that the reduced susceptibility to Fas-triggered apoptosis in B-1 cells might be an accelerating factor for the autoantibody production in NZB mice.     

CD38 signaling by agonistic monoclonal antibody prevents apoptosis of human germinal center B cells

The present study demonstrates that an agonistic anti-CD38 monoclonal antibody (mAb) (IB4) is capable of preventing apoptosis of human tonsillar germinal center (GC) B cells as measured by either morphological methods on Giemsa-stained cytospin preparations or flow cytometry on propidium iodidestained cells. Two other anti-CD38 mAb (Leu-17 and OKT10) consistently failed to prevent apoptosis in the same cells, even when tested over a wide range of concentrations. Furthermore, exposure of GC B cells to IB4 mAb up-regulates the bcl-2 proto-oncogene product in a manner similar to that observed with CD40 ligand (CD40L). The ability of IB4 mAb to prevent apoptosis of GC B cells was inferior to that of both anti-CD40 mAb and CD40L. No synergistic or additive effects were observed when IB4 mAb was used together with CD40L. Unlike anti-CD40 mAb or CD40L, IB4 mAb neither induced a proliferation of GC B cells nor increased their proliferative response to anti-CD40, CD40L or recombinant interleukin-4, used alone or in combination. The present results are consistent with the recent findings on either the feature of the CD38 molecules to deliver activation signals and on the mechanisms of selection of B cells that operates in the GC.     

The CD19 molecule is crucial for MID-dependent activation of tonsillar B cells from children

The Moraxella immunoglobulin (Ig) D-binding protein (MID) induces a strong proliferative response in human peripheral blood IgD+ B cells from adults isolated by positive selection using anti-CD19-conjugated microbeads. Here, we show that tonsillar B cells from children isolated with positive selection are unable to respond to MID stimulation. The proliferative response was very low or absent at various concentrations of MID tested and at different time points analysed, whereas the MID response of tonsillar B cells from adults isolated with positive selection was considerably higher. Tonsillar B cells from children isolated with positive selection responded to formalin-fixed preparations of Moraxella catarrhalis and Staphylococcus aureus Cowan strain I. In comparison to cells isolated with positive selection, a much higher proliferative response was recorded in tonsillar B cells from children isolated with negative selection, indicating that occupation of the CD19 molecule (i.e. positive selection) inhibited the response. Indeed, the addition of anti-CD19 monoclonal antibodies (MoAb) to MID-activated tonsillar B cells from children isolated with negative selection strongly inhibited the proliferative response. In contrast, anti-CD21 MoAb at the same concentration did only show a minor inhibition on the MID-induced response. Pre-incubation of tonsillar B cells isolated from children with anti-CD19 or anti-CD21 MoAb did not affect the binding of biotin-conjugated MID as analysed by flow cytometry. These results suggest that MID-activated tonsillar B cells from children have a strong requirement for signalling through the CD19 molecule. Future experiments will further reveal the importance of CD19 and possibly other molecules for optimal activation of tonsillar B cells isolated from both children and adults.     

Anti CD5 Sustains the Proliferative Response of IgM-Activated Human CD5+B Cells

The CD5 molecule is expressed by most T cells but it is present on a minor B cell subset. Whilst several studies have provided information on the physiological role of T cell CD5, the functional role of CD5 on B lymphocytes remains unclear. To address this question, tonsillar CD5⁺ B cells were sorted by dual-colour fluorescence and FACS. Sorted cells were stimulated with polyclonal anti-IgM antibodies (Ab), and monoclonal (MoAb) F(ab')₂ fragments of anti-CD5. Proliferative responses were evaluated by enumeration of Ki-67 positive cells using quantitative flow cytometry. Co-stimulation with anti-CD5 MoAb for 3 days did not affect the anti-IgM and IL2-induced proliferation of CD5⁺ B cells. This was seen under conditions where the anti-CD5 was soluble, adsorbed to the microwells or cross-linked by anti-mouse antibodies. Fewer CD25⁺ cells were detected, however, in the presence of anti-CD5. In contrast, the proliferative response of CD5⁺ B cells prestimulated for 3 days with IL-2 and anti-IgM, was sustained in a further 3-day culture period when anti-CD5 was added. It is concluded that CD5 occupancy might provide an additional signal to activated CD5⁺ B cells favouring their proliferation and differentiation into autoantibody secreting cells.     

Tonsillar Distribution of IgA and IgG Immunocytes and Production of IgA Subclasses and J Chain in Tonsillitis Vary with the Presence or Absence of IgA Nephropathy

At the onset or in the course of IgA nephropathy (IgA NP), upper respiratory tract infections and tonsillitis are often followed by periods of gross haematuria. In a search for possible abnormalities in the tonsillar IgA- and IgG-cell system, the palatine tonsils from seven patients with IgA NP and eight controls, all 15 suffering from chronic recurrent tonsillitis, were subjected to an immunohistochemical study. Compared with the controls, tonsils of NP patients contained a significantly (P less than 0.001) increased proportion of IgA-producing cells (49.6% versus 35.7%). There was also an increase (P less than 0.001) in the ratio of IgA polymer- (J-chain-positive) to monomer-producing cells in NP tonsils compared with controls (35.0% versus 18.8%). Although the tonsillar IgA cells were generally producing mainly IgA1, this subclass was even more predominant in NP tonsils (P less than 0.03). These results are compatible with the hypothesis that in some patients with IgA NP, the polymeric IgA1 deposited in the mesangium may be of tonsillar origin.     

Failure to down-regulate Bcl-2 protein in thymic germinal center B cells in myasthenia gravis

The most unusual characteristic of myasthenia gravis (MG) is that the thymus has germinal centers (GC). Cultured thymic lymphocytes from MG patients spontaneously produce anti-acetylcholine receptor antibodies, indicating that autoreactive B cells have escaped negative selection. To investigate the underlying mechanism, we examined the expression of the apoptosis-related protein Bcl-2 in GC B cells (defined as CD19⁺ CD38⁺ cells) in the thymus in 14 MG patients using three-color flow cytometry. GC in MG patients did not show the normal down-regulation of Bcl-2 (the frequency of Bcl-2⁺ GC B cells in the MG thymus and in control tonsils 54.3 ± 16.2% versus 20.6 ± 8.0%; mean ± SD, p < 0.0001). In contrast, Bcl-2 in GC in the mediastinal lymph nodes from four patients was down-regulated to a relatively normal level. Using the terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling (TUNEL) method to detect DNA fragmentation in situ, the frequency of TUNEL⁺ cells in GC in the MG thymus was lower than in control tonsils. These results suggest that autoreactive B cells which normally undergo apoptosis in GC may survive because of Bcl-2 up-regulation in this unusual location.     

Increased dimeric IgA-producing B cells in tonsils in IgA nephropathy determined by in situ hybridization for J chain mRNA.

The origin of mesangial IgA deposits in IgA nephropathy (IgAN) remains obscure. A significant proportion of deposited immunoglobulin is dimeric (J chain-positive). Previous studies of J chain expression within lymphoid tissue in IgAN have utilized antibodies which other investigators have found to be non-specific. To address this problem, we have developed and in situ hybridization (ISH) method for the detection of J chain mRNA within IgA plasma cells. Tonsils from 12 patients with IgAN and 12 controls were studied using (i) non-isotopic ISH for J chain mRNA, and (ii) combined immunofluorescence (IF) and fluorescent ISH. J chain mRNA-positive cells were identified in germinal centres, and within the subepithelial and interfollicular zones. A greater number of J chain mRNA-positive cells were found in the germinal centres of patients (mean 57.7 +/- 4.6 cells/10(5) micron2) compared with controls (mean 36.9 +/- 3.5 cells/10(5) micron2) (P < 0.001). Combined IF and fluorescent ISH showed a greater proportion of J chain mRNA-positive interfollicular IgA cells in patient tonsils (32 +/- 3.4%) compared with controls (21 +/- 2.3%; P < 0.02). These results indicate a shift towards dimeric IgA production in the tonsils in IgAN. In addition, the finding of excess numbers of J chain-positive Iga-negative cells within germinal centres suggests that an abnormality may be present at the B cell differentiation stage before IgA switching. These results further highlight immune abnormalities within the tonsil as a central feature of abnormal polymeric IgA biology in this common form of glomerulonephritis.