[HTML][HTML] Lentiviral-mediated gene therapy restores B cell tolerance in Wiskott-Aldrich syndrome patients

F Pala, H Morbach, MC Castiello… - The Journal of …, 2015 - Am Soc Clin Investig
F Pala, H Morbach, MC Castiello, JN Schickel, S Scaramuzza, N Chamberlain, B Cassani…
The Journal of clinical investigation, 2015Am Soc Clin Investig
Wiskott-Aldrich syndrome (WAS) is an X-linked immunodeficiency characterized by
microthrombocytopenia, eczema, and high susceptibility to developing tumors and
autoimmunity. Recent evidence suggests that B cells may be key players in the
pathogenesis of autoimmunity in WAS. Here, we assessed whether WAS protein deficiency
(WASp deficiency) affects the establishment of B cell tolerance by testing the reactivity of
recombinant antibodies isolated from single B cells from 4 WAS patients before and after …
Wiskott-Aldrich syndrome (WAS) is an X-linked immunodeficiency characterized by microthrombocytopenia, eczema, and high susceptibility to developing tumors and autoimmunity. Recent evidence suggests that B cells may be key players in the pathogenesis of autoimmunity in WAS. Here, we assessed whether WAS protein deficiency (WASp deficiency) affects the establishment of B cell tolerance by testing the reactivity of recombinant antibodies isolated from single B cells from 4 WAS patients before and after gene therapy (GT). We found that pre-GT WASp-deficient B cells were hyperreactive to B cell receptor stimulation (BCR stimulation). This hyperreactivity correlated with decreased frequency of autoreactive new emigrant/transitional B cells exiting the BM, indicating that the BCR signaling threshold plays a major role in the regulation of central B cell tolerance. In contrast, mature naive B cells from WAS patients were enriched in self-reactive clones, revealing that peripheral B cell tolerance checkpoint dysfunction is associated with impaired suppressive function of WAS regulatory T cells. The introduction of functional WASp by GT corrected the alterations of both central and peripheral B cell tolerance checkpoints. We conclude that WASp plays an important role in the establishment and maintenance of B cell tolerance in humans and that restoration of WASp by GT is able to restore B cell tolerance in WAS patients.
The Journal of Clinical Investigation