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

J Clin Invest. 2015 Oct 1;125(10):3941-51. doi: 10.1172/JCI82249. Epub 2015 Sep 14.

Abstract

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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Amino Acid Sequence
  • B-Lymphocytes / immunology*
  • Bone Marrow / pathology
  • Child
  • Child, Preschool
  • Clonal Deletion
  • Clone Cells / immunology
  • Genetic Therapy*
  • Genetic Vectors / therapeutic use*
  • Humans
  • Immune Tolerance*
  • Lentivirus / genetics
  • Male
  • Molecular Sequence Data
  • Receptors, Antigen, B-Cell / immunology
  • Recombinant Fusion Proteins
  • T-Lymphocytes, Regulatory / immunology
  • Wiskott-Aldrich Syndrome / immunology
  • Wiskott-Aldrich Syndrome / therapy*
  • Wiskott-Aldrich Syndrome Protein / deficiency
  • Wiskott-Aldrich Syndrome Protein / genetics
  • Wiskott-Aldrich Syndrome Protein / therapeutic use*

Substances

  • Receptors, Antigen, B-Cell
  • Recombinant Fusion Proteins
  • WAS protein, human
  • Wiskott-Aldrich Syndrome Protein