title: [B lymphocyte differentiation in granulomatous tissues of the lung and the nasal mucosa in Wegener's granulomatosis: origin of anti-neutrophil cytoplasmic antibody formation?].
abstract: Wegener's granulomatosis (WG) starts with granulomatous inflammation of the respiratory tract before it converts into a potentially organ and life threatening systemic vasculitis associated with anti-neutrophil cytoplasmic antibodies (ANCA). The site of formation of the highly specific ANCA directed against "Wegener's autoantigen" proteinase 3 (PR3) is still unknown. Previously, we have shown that follicle-like B lymphocytic infiltrates in the vicinity to PR3 expressing cells in WG-granulomata. We characterized the immunoglobulin-VH repertoire in lung and nasal granulomata (paraffin embedded) from four WG patients. A total of 115 individual VH genes were characterized and compared to 84 VH genes from the peripheral blood of a healthy donor. We found an increased frequency of mutations with a bias to amino acid exchanges within the antigen binding sites (CDR) 1 and 2 in WG tissue. A large number of mutations led to negatively charged amino acids and may increase affinity to the positively charged PR3. Furthermore, the occurrence of differently mutated members of one B cell clone indicates clonal expansion and intraclonal diversification by an antigen, e.g. PR3. Several WG tissue derived genes displayed similarities to published sequences from peripheral PR3 ANCA producing B cells. Thus, granulomata of the lower and upper respiratory tract contain follicle-like B cell clusters with a selected VH repertoire infiltrate in WG. WG granulomata could be the place of autoantigen presentation and formation of high-affinity ANCA within neoformed ectopic or tertiary lymphoid-like tissue areas.
authors.affiliation: Poliklinik für Rheumatologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck und Rheumaklinik Bad Bramstedt, Ratzeburger Allee 160, 23538, Lübeck, Germany. ja-kraemer@web.de
authors.forename: J A
authors.initials: JA
authors.lastname: Krämer
authors.forename: A
authors.initials: A
authors.lastname: Müller
authors.forename: K
authors.initials: K
authors.lastname: Herlyn
authors.forename: S
authors.initials: S
authors.lastname: Pitann
authors.forename: P
authors.initials: P
authors.lastname: Lamprecht
authors.forename: K
authors.initials: K
authors.lastname: Holl-Ulrich
authors.forename: A C
authors.initials: AC
authors.lastname: Feller
authors.forename: W L
authors.initials: WL
authors.lastname: Gross
authors.forename: A
authors.initials: A
authors.lastname: Gause
authors.forename: J
authors.initials: J
authors.lastname: Voswinkel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000378:metabolism*; D001323:Autoantibodies / Q000097:blood / Q000235:genetics; D001402:B-Lymphocytes / Q000276:immunology*; D001706:Biopsy; D004252:DNA Mutational Analysis; D050438:Genes, Immunoglobulin Heavy Chain / Q000235:genetics; D014890:Granulomatosis with Polyangiitis / Q000235:genetics / Q000276:immunology* / Q000473:pathology; D006801:Humans; D007124:Immunoenzyme Techniques; D008168:Lung / Q000276:immunology* / Q000473:pathology; D008213:Lymphocyte Activation / Q000276:immunology*; D008875:Middle Aged; D053146:Myeloblastin / Q000276:immunology; D009297:Nasal Mucosa / Q000276:immunology* / Q000473:pathology
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D001323:Autoantibodies; D053146:Myeloblastin