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

Journal Article (Clinical Trial;Journal Article)

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 IRF4 and IRF8, each critical to B-cell differentiation and fate. All-trans retinoic acid (ATRA) increased IRF4 expression, restored the IRF4-to-IRF8 ratio, abrogated BCR-NOTCH hyperactivation, and reduced NOTCH2 expression in cGVHD B cells without compromising viability. ATRA-treated cGVHD B cells had elevated TLR9 and PAX5, but not BLIMP1 (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.

Full Text

Duke Authors

Cited Authors

  • Poe, JC; Jia, W; Su, H; Anand, S; Rose, JJ; Tata, PV; Suthers, AN; Jones, CD; Kuan, PF; Vincent, BG; Serody, JS; Horwitz, ME; Ho, VT; Pavletic, SZ; Hakim, FT; Owzar, K; Zhang, D; Blazar, BR; Siebel, CW; Chao, NJ; Maillard, I; Sarantopoulos, S

Published Date

  • November 9, 2017

Published In

Volume / Issue

  • 130 / 19

Start / End Page

  • 2131 - 2145

PubMed ID

  • 28851699

Pubmed Central ID

  • PMC5680609

Electronic International Standard Serial Number (EISSN)

  • 1528-0020

Digital Object Identifier (DOI)

  • 10.1182/blood-2017-05-782466


  • eng

Conference Location

  • United States