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Blood, 1 March 2005, Vol. 105, No. 5, pp. 2007-2015.
Prepublished online as a Blood First Edition Paper on July 29, 2004; DOI 10.1182/blood-2003-10-3563.
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Submitted October 21, 2003
Accepted June 15, 2004
Rh Autoantigen presentation to helper T cells in chronic lymphocytic leukemia by malignant B-cells
Andrew M Hall, Mark A Vickers, Ewan McLeod, and Robert N Barker*
Department of Medicine and Therapeutics, Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
* Corresponding author; email: r.n.barker{at}abdn.ac.uk.
Chronic lymphocytic leukemia (CLL) is frequently associated with autoimmune diseases directed against constituents of the blood, including hemolytic anemia (AIHA). We hypothesized that CLL cells predispose to hematological autoimmunity by acting as aberrant antigen presenting cells (APC). Initially, it was confirmed that all studied patients with AIHA secondary to CLL harbored activated Th cells specific for epitopes on the dominant red blood cell (RBC) autoantigens in primary AIHA, the Rh proteins. Rh specific Th cells were also detected in a number of CLL patients who, although they did not suffer AIHA, had low levels of anti-RBC antibody in their serum. Fractionation of putative APC populations from the peripheral blood of patients by negative selection showed that CD5+ CLL cells are the most effective cell type in processing and presenting purified Rh protein to autoreactive Th cells. This ability was confirmed using positively selected CD5+ CLL cells. Thus, our study provides the first evidence for malignant cells driving an autoimmune response by acting as aberrant APC.

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