An aberrant NOTCH2-BCR signaling axis in B cells from patients with chronic GVHD.

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Blood, ISSN: 1528-0020, Vol: 130, Issue: 19, Page: 2131-2145

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Poe, Jonathan C; Jia, Wei; Su, Hsuan; Anand, Sarah; Rose, Jeremy J; Tata, Prasanthi V; Suthers, Amy N; Jones, Corbin D; Kuan, Pei Fen; Vincent, Benjamin G; Serody, Jonathan S; Horwitz, Mitchell E; Ho, Vincent T; Pavletic, Steven Z; Hakim, Frances T; Owzar, Kouros; Zhang, Dadong; Blazar, Bruce R; Siebel, Christian W; Chao, Nelson J; Maillard, Ivan; Sarantopoulos, Stefanie Show More Hide
American Society of Hematology
Biochemistry, Genetics and Molecular Biology; Immunology and Microbiology; Medicine
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article description
B-cell receptor (BCR)-activated B cells contribute to pathogenesis in chronic graft-versus-host disease (cGVHD), a condition manifested by both B-cell autoreactivity and immune deficiency. We hypothesized that constitutive BCR activation precluded functional B-cell maturation in cGVHD. To address this, we examined BCR-NOTCH2 synergy because NOTCH has been shown to increase BCR responsiveness in normal mouse B cells. We conducted ex vivo activation and signaling assays of 30 primary samples from hematopoietic stem cell transplantation patients with and without cGVHD. Consistent with a molecular link between pathways, we found that BCR-NOTCH activation significantly increased the proximal BCR adapter protein BLNK. BCR-NOTCH activation also enabled persistent NOTCH2 surface expression, suggesting a positive feedback loop. Specific NOTCH2 blockade eliminated NOTCH-BCR activation and significantly altered NOTCH downstream targets and B-cell maturation/effector molecules. Examination of the molecular underpinnings of this "NOTCH2-BCR axis" in cGVHD revealed imbalanced expression of the transcription factors and , each critical to B-cell differentiation and fate. All- retinoic acid (ATRA) increased expression, restored the -to- ratio, abrogated BCR-NOTCH hyperactivation, and reduced NOTCH2 expression in cGVHD B cells without compromising viability. ATRA-treated cGVHD B cells had elevated and , but not (a gene-expression pattern associated with mature follicular B cells) and also attained increased cytosine guanine dinucleotide responsiveness. Together, we reveal a mechanistic link between NOTCH2 activation and robust BCR responses to otherwise suboptimal amounts of surrogate antigen. Our findings suggest that peripheral B cells in cGVHD patients can be pharmacologically directed from hyperactivation toward maturity.