Increased dimeric IgA producing B cells in the bone marrow in IgA nephropathy determined by in situ hybridisation for J chain mRNA.

AIM: To investigate the possible role of the systemic IgA immune system in the pathogenesis of IgA nephropathy METHODS: J chain mRNA expression in the IgA cells of the bone marrow was studied. Bone marrow trephine biopsy specimens from seven patients with IgA nephropathy and seven matched controls were examined by (1) non-isotopic in situ hybridisation (ISH) and (2) combined immunofluorescence and non-isotopic ISH to identify the plasma cell type. Serum polymeric IgA was also determined using standard high pressure liquid chromatography and sandwich enzyme linked immunosorbent assay. RESULTS: Non-isotopic ISH revealed a similar number of J chain mRNA positive cells/unit length in biopsy specimens from patients (16.5 +/- 2.7 cells/mm) and controls (17.7 +/- 2.4 cells/mm). Combined immunofluorescence and ISH revealed a greater proportion of J chain mRNA positive IgA cells in patients (7.6 +/- 1.45%) compared with controls (3 +/- 0.8%). Serum polymeric IgA was similar in both patients (91 +/- 22 mg/l) and controls (77 +/- 24 mg/l). CONCLUSION: These data suggest that excess production of dimeric IgA occurs in the bone marrow in IgA nephropathy.     

J chain synthesis in lymphocytes from patients with selective IgA deficiency.

J chain synthesis was investigated by in vitro pokeweed mitogen (PWM) stimulated peripheral blood lymphocyte (PBL) cultures in eight patients with selective IgA deficiency and compared with that of normal persons. In normals, all IgM-containing cells always had the J chain but only in a portion of IgG- and IgA-containing cells was J chain detectable. The percentage of J chain-positive cells amongst IgG or IgA cells increased during culture, reached a peak at days 5-6 or 6-7, respectively, and then decreased. IgA-deficient patients had very few IgA-containing cells and an increased number and percentage of J chain-positive IgG cells, except for one patient, who had a significant number of IgA-containing cells without IgA secretion into the culture supernatants. Measurement of Ig in culture supernatants by radioimmunoassay revealed that lymphocytes from seven patients secreted significantly smaller amounts of IgG and IgM than did the normal controls, in addition to the defect in IgA production. These results suggested the presence of some ontogenetic relationship between J chain-positive IgG cells and the precursors of IgA-producing cells, and some functional immaturity of most IgG-producing clones seen in patients with selective IgA deficiency.     

Preliminary characterization and distribution of vicia villosa binding cells in human tonsils

Summary The lectin Vicia villosa (VV) has been used for the separation of human and murine contrasuppressor T cells. These cells were characterized in cryostat sections of human palatine tonsils by double staining with VV lectin and monoclonal antibodies to macrophages, lymphocytes and their subsets using a fluorescein-rhodamine technique. VV lectin had an affinity for the CD8⁺ subset of lymphocytes and for a subset of macrophages within the germinal centre. The number and distribution of VV lectin binding cells was studied in paraffin sections of formalin fixed tonsils by the avidin-biotin-peroxidase technique. Positive cells in the germinal centres, mantle, interfollicular zones and fibrous connective tissue septa were quantified using an image analyser. These were found in greatest density in the interfollicular zone, correlating with the known distribution of T cells in human palatine tonsils. The binding of VV lectin to a subset of macrophages appears not to have previously been described nor have VV lectin binding CD8⁺ lymphocytes been demonstrated in sections of human tissues.     

Reactive and neoplastic human lymphoid cells producing J chain in the absence of immunoglobulin: evidence for the existence of 'J chain disease'?

The initiation of cytoplasmic Ig synthesis in differentiating B cells is accompanied by the start of cytoplasmic J chain production. As the cell matures further, J chain synthesis ceases (unless it is producing dimeric IgA or 19S IgM). In consequence, it is common to find Ig-positive, J chain-negative cells in reactive lymphoid tissue. However, the reverse pattern (Ig-negative/J chain-positive), which would indicate J chain production unaccompanied by Ig synthesis, has not been reported. In this paper we describe the detection of such cells in reactive human lymphoid tissue by a double immunoenzymatic labelling technique. Furthermore, retrospective immunohistological analysis of 90 cases of human high-grade lymphoma revealed three cases in which the neoplastic cells appeared to synthesize J chain but not Ig. These findings suggest that the term J chain disease might be introduced to describe this new class of lymphoid neoplasm. However, it is pointed out that immunochemical categories of human B lymphoproliferative diseases based upon patterns of Ig synthesis are often in direct conflict with histological categories (cf. mu chain-producing neoplasms) and the term J chain disease cannot therefore be recommended. It is probable that further cases of J chain-positive, Ig-negative lymphoid neoplasms, covering a range of histological categories, will be described in the future.     

Analysis of human IgA subclasses by in situ hybridization and combined in situ hybridization/immunohistochemistry.

In this report we describe a method for the analysis of the cellular expression of the two human IgA subclasses by in situ hybridization (ISH). The technique permits the detection of specific mRNA in individual cells using 35S-labeled oligonucleotide probes without any detectable cross-hybridization between the subclasses. This method was applicable both on cytospin preparation of peripheral blood mononuclear cells as well as in formalin-fixed, paraffin-embedded tissue sections. Furthermore, we describe a combined ISH/immunohistochemistry technique for the simultaneous detection of IgA subclass mRNA and protein at the single cell level. Examination of tissue sections from tonsils revealed a striking localization of labeled cells within the germinal center of some of the lymphoid follicles. The implications of this novel finding and the development of the method are discussed.     

The glycans deficiencies of macromolecular IgA1 is a contributory factor of variable pathological phenotypes of IgA nephropathy

Recent evidence has suggested that IgA1-containing macromolecules and the glycosylation of IgA1 in sera from patients with IgAN might involve the pathogenesis of IgAN. However, whether the different histological phenotypes can be attributed or not to the aberrant glycosylation of macromolecular IgA1 has not yet been elucidated. The aim of the current study is to investigate the glycosylation of IgA1 molecules in serum IgA1-containing macromolecules and their association with pathological phenotypes of IgAN. Sera was collected from 40 patients with IgAN and 20 donors. Twenty patients had mild mesangial proliferative IgAN, the remaining 20 had focal proliferative sclerosing IgAN. Polyethylene glycol 6000 was used to precipitate the macromolecules from sera of patients and controls. Biotinylated lectins were used in an enzyme-linked immunosorbent assay (ELISA) to examine different glycans on IgA1 molecules. The alpha2,6 sialic acid was detected by elderberry bark lectin (SNA) and the exposure of terminal galactose (Gal) and N-acetylgalactosamine (GalNAc) were detected by Arachis hypogaea (PNA) and Vilsa villosa lectin (VVL), respectively. The IgA1 glycans levels corrected by IgA1 concentrations were compared between patients and controls. Reduced terminal alpha2,6 sialic acid of IgA1 (79.89 +/- 25.17 versus 62.12 +/- 24.50, P = 0.034) was demonstrated only in precipitates from sera of patients with focal proliferative sclerosing IgAN, compared with those from controls. Reduced galactosylation of IgA1 molecules in precipitates was demonstrated in patients with both mild mesangial proliferative IgAN and focal proliferative sclerosing IgAN compared with normal controls (24.52 +/- 18.71 versus 76.84 +/- 32.59 P = 0.000 and 33.48 +/- 25.36 versus 76.84 +/- 32.59 P = 0.000). However, no significant difference was found in IgA1 glycosylation in the supernatant between patients and normal controls (P > 0.05). The glycosylation deficiency of IgA1 existed only in serum IgA1-containing macromolecules of patients with IgAN, and was associated with the renal pathological phenotypes. This suggests that aberrant glycosylation of IgA1 in serum macromolecules might be a contributory factor in the pathogenesis of IgAN.     

Terminally differentiated human intestinal B cells. J chain expression of IgA and IgG subclass-producing immunocytes in the distal ileum compared with mesenteric and peripheral lymph nodes

Two-colour immunofluorescence staining for intracellular J chain and IgA (or J chain and IgG) was performed on tissue sections of normal human ileal mucosa (eight adult kidney donors), mesenteric lymph nodes (MLN), peripheral lymph nodes, and palatine tonsils. The most prominent J chain positivity was seen for IgA (97.3%) and IgG (81.7%) immunocytes in the ileal lamina propria (LP). Moreover, the proportion of J chain-expressing extrafollicular immunocytes was significantly higher (P less than 0.05) in MLN than in peripheral lymph nodes for the IgA class (58.5% versus 25.6%); the same proportion for the IgG class was 45.9% versus 30.4%. In clinically normal palatine tonsils of adults, extrafollicular J chain expression was much lower than in peripheral lymph nodes; 14.2% for IgA cells and 5.5% for IgG cells. When related to subclass production, J chain expression was found to be higher for IgA2 than for IgA1 cells in all tissues examined (palatine tonsils excluded because of a small number of IgA2 cells), the difference being significant in MLN and ileal LP (P less than 0.05). The J chain positivity tended to be higher for all IgG subclasses in MLN than in peripheral lymph nodes; this difference was significant (P less than 0.05) for IgG2-producing immunocytes. Taking J chain expression as a marker of clonal immaturity, our results may reflect to some extent distribution of newly generated memory B cell clones from gut-associated lymphoid tissue to MLN, peripheral lymph nodes, and palatine tonsils in a strikingly decreasing order.     

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.     

Selective distribution and quantitation of T-lymphocyte subsets in germinal centers of human tonsils. Definition by use of monoclonal antibodies

The distribution and quantitation of T-lymphocyte subpopulations of human tonsils were studied in situ by the avidinbiotin-peroxidase technique, using monoclonal antibodies to total, helper, and suppressor T cells. Primary follicles contained few T lymphocytes. The germinal centers of secondary follicles contained numerous T cells: in the periphery, 14.2% +/- 1.7% (mean +/- SD), and in the central area, 2.4% +/- 0.7%, of follicular lymphocytes counted were T lymphocytes. The mantle zone had fewer T lymphocytes (7% +/- 0.9%). Most of the T lymphocytes found in the germinal centers had the helper-cell phenotype. There were fewer than 1% of suppressor T lymphocytes in the germinal centers. An occasional secondary follicle could contain up to 10% of suppressor cells (range, 0% to 9.7%). The interfollicular areas contained preponderantly T lymphocytes, a majority of which reacted with monoclonal antibodies to helper cells. The distribution and enumeration of T lymphocytes in normal reactive lymphoid tissue provide a basis for studies of pathological specimens.     

Reduced Number of CD8+ Cells in Tonsillar Germinal Centres in Children with the Periodic Fever,Aphthous Stomatitis,Pharyngitis and Cervical Adenitis Syndrome

The syndrome of periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) is an autoinflammatory disorder of unknown aetiology. Tonsillectomy may cause a prompt resolution of the syndrome. The aim was to study the histologic and immunological aspects of the palatine tonsils in PFAPA, to help understand the pathophysiology of the syndrome. Tonsils from children with PFAPA (n = 11) and children with tonsillar hypertrophy (n = 16) were evaluated histologically after haematoxylin and eosin staining. The number of different cell types was identified immunohistochemically by cluster of differentiation (CD) markers: CD3 (T cells), CD4 (T helper cells), CD8 (cytotoxic T cells), CD15 (neutrophils), CD20 (B cells), CD45 (all leucocytes), CD57 (NK cells) and CD163 (monocytes and macrophages). Tonsils from children with PFAPA showed reactive lymphoid hyperplasia dominated by well‐developed germinal centres with many tingible body macrophages. The histologic findings were unspecific, and a similar morphologic appearance was also found in the tonsils from controls. The number of CD8+ cells in germinal centres differed between children with PFAPA [median 9 cells (quartiles: 5, 15)] and controls [18 cells (12, 33) (P = 0.001)] and between children with PFAPA with (median 14 cells; 9, 16) and without (4 cells; 3, 8) aphthous stomatitis (P = 0.015). For the other cell types, no differences in germinal centres were found between children with PFAPA and controls. In conclusion, a lower number of CD8+ cells were found in germinal centres of tonsils in children with PFAPA compared to controls, which may be a feature linked to the aetiology of the syndrome.     

Zonal distribution of immunoglobulin-synthesizing cells within the germinal centre: an in situ hybridization and immunohistochemical study

Immunohistologic studies have shown that synthesis of cytoplasmic immunoglobulin (cIg) is a normal function of some follicle centre cells (FCCs). The mechanisms regulating this synthesis of immunoglobulin and its function within the germinal centre are still poorly understood. In this study we applied a recently developed in situ hybridization method for the detection of kappa and lambda light chain mRNA to reactive lymph nodes and tonsils in order to investigate further the immunoglobulin-synthesizing cells of the germinal centre. FCCs containing detectable levels of light chain mRNA corresponded closely to cells containing cIg. The detection of light chain mRNA rather than its immunoglobulin product was found to be an advantage in that problems associated with the detection of extracellular immunoglobulin were eliminated. This was most apparent in germinal centres where the absence of 'network' immunoglobulin led to the observations that immunoglobulin-synthesizing FCCs are predominantly small centrocytes and that in a proportion of germinal centres they localize in that part of the light zone closest to the dark zone. This zonal distribution of immunoglobulin-synthesizing FCCs raises the possibility of further functional and micro-environmental subcompartments within the light zone.     

Significance of different J chain profiles in human tissues: generation of IgA and IgM with binding site for secretory component is related to the J chain expressing capacity of the total local immunocyte population, including IgG and IgD producing cells, and depends on the clinical state of the tissue

Most IgA producing cells in normal intestinal and nasal mucosa synthesize dimers or larger polymers as evidenced by 90% cytoplasmic affinity for secretory component (SC) in vitro and almost 100% J chain positivity. The comparable median figures for normal exocrine glands (salivary, lacrimal, lactating mammary) were 84% and 92%, respectively. Conversely, IgA immunocytes in the subepithelial areas of palatine tonsils and in other extraglandular tissues, such as inflamed gingiva and intestinal submucosa, showed only 16-28% SC binding capacity and 18-51% J chain positivity. Similarly decreasing J chain expression, from glandular to extraglandular sites, was revealed not only for IgM immunocytes but also for those producing IgD or IgG, particularly the latter. This observation indicated more extensive overall clonal maturation in tissues without glandular elements since J chain expression seems to be a feature of relatively early memory B cells. The results were supported by studies in patients with selective IgA deficiency. Inflammatory disease caused significantly reduced SC binding capacity of IgA cells, both in intestinal mucosa and tonsils; this change was paralleled by decreased J chain expression, not only for mucosal and tonsillar IgA cells but also for mucosal IgG cells, suggesting local appearance of more mature clones. The resulting change to production of monomeric IgA may adversely affect secretory immunity and thus contribute to perpetuation of chronic inflammatory disease.     

Increase in tonsillar germinal centre B-1 cell numbers in IgA nephropathy (IgAN) patients and reduced susceptibility to Fas-mediated apoptosis

IgAN is a common form of primary glomerulonephritis and also a disease of tonsillar focal infection. The comprehensive mechanism underlying this disease remains to be defined. To better understand its pathogenesis, we investigated tonsillar CD5+ B cells (B-1 cells) with respect to IgA synthesis. Germinal centre (GC) B cells were isolated from the tonsils of IgAN patients and the number of B-1 cells in the GC determined by flow cytometry. GC B-1 and B-2 (CD5- B) cells were purified by cell sorter, the cells were incubated with agonist anti-CD40 MoAb and the ability for antibody production by B-1 and B-2 cells determined by ELISPOT assay. GC B-1 cells and B-2 cells were incubated with agonist anti-Fas MoAb, and apoptosis in GC B-1 cells and B-2 cells was analysed by flow cytometry. Although B-1 cells do not usually take part in the GC reaction, an increase in B-1 cell numbers was observed in the GC of tonsils from IgAN patients. These B-1 cells were likely IgA1 antibody-producing cells, since the prominent IgA subclass in IgAN is generally considered to be IgA1. Although Fas-dependent apoptosis is essential for the elimination of activated B cells, these B-1 cells showed a reduced susceptibility to Fas-mediated apoptosis. It is conceivable that activated B-1 cells may survive in the GC due to impaired apoptosis and thus produce abnormal antibodies. These findings suggest that the immune responses of B-1 cells in the tonsillar GC could thus have an impact on the pathogenesis of IgAN.     

Binding capacity and pathophysiological effects of IgA1 from patients with IgA nephropathy on human glomerular mesangial cells

IgA deposition in glomerular mesangium and the interaction with mesangial cells may well be the final common pathway to IgA nephropathy (IgAN). Altered hinge-region O-glycosylation of IgA1 from patients with IgAN may predispose to mesangial deposition and activation of the mesangial cell (MC) by IgA1, via a novel IgA1 receptor, and may be a key event in the pathogensis of IgAN. The aim of this study was to investigate the binding capacity and biological effects of IgA1, from both patients with IgAN and healthy controls, on human mesangial cells (HMC). Serum IgA1 was isolated with jacalin affinity chromatography, heated to aggregated form (aIgA1) and labelled with (125)I. Binding capacity of aIgA1 in vitro to cultured primary HMC was evaluated by a radioligand binding assay and the specificity of binding was determined by a competitive inhibition assay. Intracellular calcium release was studied by confocal analysis and phosphorylation of extracellular signal-regulated kinase (ERK) was determined by Western blot analysis. Change of cell cycles was demonstrated by flow cytometry and HMC proliferation was evaluated by direct cell count. Expression of TGF-beta mRNA and production of supernatant fibronectin were tested by RT-PCR and indirect competitive ELISA, respectively. aIgA1 from both the patients with IgAN and normal controls bound to HMC in a dose-dependent, saturable manner, and was saturated at approximately 500 pmoles per 0.5 ml of aIgA1. aIgA1 from patients with IgAN, however, bound to HMC at a higher speed and Scatchard analysis revealed a Kd of (8.89 +/- 2.1) x 10(-8)m versus (4.3 +/- 1.2) x 10(-7)m for aIgA1 from healthy controls (P = 0.026).The binding was specific because it was only inhibited by unlabelled Mono-IgA1 (mIgA1) and not by serum albumin or IgG. aIgA1 from patients with IgAN could induce release of intracellular calcium, phosphorylation of ERK, DNA synthesis, proliferation of HMC, expression of TGF-betamRNA and secretion of fibronectin in HMC in a similar time-dependent manner as aIgA1 from healthy controls, but the effects were much stronger and the durations were much longer (P < 0.05, respectively). We conclude that aIgA1 from patients with IgAN has a higher binding capacity to HMC and stronger biological effects than aIgA1 from healthy controls. This suggests that direct interaction between IgA1 and HMC and subsequential pathophysiological responses may play an important role in the pathogenesis for IgAN.     

Aberrant sialylation of serum IgA1 was associated with prognosis of patients with IgA nephropathy

Aberrant glycosylation of serum IgA1 was considered as an initial event and involvement in the pathogenesis of IgAN. We previously demonstrated that aberrant glycosylation of serum IgA1 was associated with pathologic phenotype of IgAN. The present study is to investigate if abnormal sialylation of IgA1 affects renal survival of IgAN. 127 patients with biopsy-proven IgAN were enrolled and followed up to 8 years. Seventy-nine healthy and 75 patients with non-IgAN renal diseases were selected as controls. Alpha 2, 6 sialic acid (SA) of serum IgA1 was measured by sandwich-ELISA. Renal survival rate was estimated by Kaplan-Meier method. Alpha 2, 6 SA level in patients with IgAN was lower than that in healthy controls (0.92+/-0.14 vs. 0.98+/-0.12, P=0.001) and non-IgAN glomerulonephritis (0.92+/-0.14 vs. 1.00+/-0.18, n=53, P=0.001). Patients with IgAN in Low SA Group were no significant differences compared with patients in Normal SA Group in age, gender, hypertension, serum creatinine, and excretion of proteinuria. Renal cumulative survival rate was 53.3% in patients in Low SA Group and 83.5% in Normal SA Group (P=0.0008). The lower the alpha 2, 6 SA level of serum IgA1 in patients with IgAN was, the worse their renal survival rate was. Although patients in Low SA Group had worse renal function evaluated by eGFR, there was no significant difference in various CKD stages in non-IgAN renal function controls (n=42, P=0.352). Alpha 2, 6 SA level of serum IgA1 was associated with the prognosis of patients with IgAN and could serve as a predictor of poor prognosis in IgAN.     

T-cell receptor repertoire in human germinal centres

A search for an antigen-driven expansion of T lymphocytes in the inflamed joints in rheumatoid arthritis (RA) patients have been going on for decades. We here analyzed the human germinal centre T-cell receptor (TCR) Vbeta gene usage with polymerase chain reaction (PCR) combined with sequence analysis, to address the question of clonality in tonsils and synovial tissue from RA patients. Our data show a large degree of TCR heterogeneity in both these histological structures. Furthermore, clonally related T cells were found within different closely located germinal centres indicating either an active T-cell migration between germinal centres (GC) or that a T-cell clone may seed more than one GC.     

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.     

Immunological abnormalities in the tonsils of patients with IgA nephropathy: inversion in the ratio of IgA: IgG bearing lymphocytes and increased polymeric IgA synthesis

In the last few years the mucosal origin of the IgA deposited in the kidneys of patients with IgA nephropathy has been examined by several investigators. We have previously presented evidence that polymeric IgA may have a predominant role in the pathogenesis of IgA nephropathy. Taking into account that these patients often present with macroscopic haematuria following respiratory tract infections we have studied the possible existence of immunological abnormalities in the tonsils of patients with IgA nephropathy. Six patients and 13 controls suffering from chronic tonsillitis were submitted to tonsillectomy. Patients with IgA nephropathy showed a significant increase (P less than 0.00025) in IgA bearing lymphocytes (14.4 +/- 2.3) and a significant decrease (P less than 0.025) in IgG bearing lymphocytes (20.5 +/- 4.6) compared to the control group (2.9 +/- 1.4 and 31.6 +/- 3.6, respectively). After 7 days of culture with pokeweed mitogen the percentage of tonsillar cells producing polymeric IgA was significantly higher in the patients than in the controls (66.5 +/- 12.6 vs 33.4 +/- 10.3; P less than 0.005). These results also suggest a mucosal origin for the IgA deposited in the kidneys of these patients. Our data are consistent with the existence of an immunoregulatory dysfunction in the secretory immune system of patients with IgA nephropathy.