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Blood, 1 April 2004, Vol. 103, No. 7, pp. 2683-2690.
Prepublished online as a Blood First Edition Paper on November 26, 2003; DOI 10.1182/blood-2003-08-2632.

Submitted August 1, 2003
Accepted November 20, 2003
B-cell negative selection and terminal differentiation are defective in the ICF syndrome
Carla E Blanco-Betancourt, Anne Moncla, Michele Milili, Yun Liang Jiang, Evani M Viegas-Pequignot, Bertrand Roquelaure, Isabelle Thuret, and Claudine Schiff*
Centre d'Immunologie de Marseille-Luminy, Marseille, France
Departement de Genetique, Service de Gastroenterologie and Service d Hematologie Pediatrique, Hopital d'enfants de la Timone, Marseille, France
Institut Jacques Monod, Paris, France
* Corresponding author; email: schiff{at}ciml.univ-mrs.fr.
ICF syndrome is a rare autosomal recessive disease characterized by variable Immunodeficiency, Centromeric instability and Facial anomalies. Mutations in the DNA methyltransferase 3B (DNMT3B) gene are responsible for most ICF cases reported. We investigated the B cell defects associated with agammaglobulinemia in this syndrome by analyzing primary B cells from 4 ICF patients. ICF peripheral blood (PB) contains only naive B cells and memory and gut plasma cells are absent. Naive ICF B cells bear potentially autoreactive long VH CDR3s enriched with positively charged residues, in contrast to normal PB transitional and mature B cells, indicating that negative selection is impaired in patients. Like anergic B cells in transgenic models, newly generated and immature B cells accumulate in PB. Moreover, these cells secrete Igs and exhibit increased apoptosis following in vitro activation. However, they are able to upregulate CD86, indicating that mechanisms other than anergy participate in silencing of ICF B cells. One patient without DNMT3B mutations shows differences in IgE switch induction, suggesting that immunodeficiency could vary with the genetic origin of the syndrome. In this study, we determined that negative selection breakdown and peripheral B cell maturation blockage contribute to agammaglobulinemia in the ICF syndrome.

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