S. Nonoyama et al., FUNCTIONAL-ANALYSIS OF PERIPHERAL-BLOOD B-CELLS IN PATIENTS WITH X-LINKED AGAMMAGLOBULINEMIA, The Journal of immunology (1950), 161(8), 1998, pp. 3925-3929
X-linked agammaglobulinemia (XLA) is a primary immunodeficiency diseas
e caused by mutations of Bruton tyrosine kinase (Btk); Btk plays an es
sential role in the development of mature B cells. However, small numb
ers of B cells (''leaky B cells'') are present in the peripheral blood
of most XLA patients. In this study, we analyzed the function of thes
e leaky B cells obtained from XLA patients. Enough numbers of B cells
were available for analysis from five of mine XLA patients originally
screened. Sequence analysis revealed missense mutations of Btk in four
of the five XLA patients. No mutation was found in the coding region
of Btk in one patient, Western blotting and/or flow cytometric analysi
s failed to detect Btk protein in all five patients. B cells isolated
from peripheral blood of these XLA patients were CD5(-), CD20(+), CD19
(+), and CD21(--). If stimulated with anti-CD40 and IL-4, XLA B cells
proliferated normally and produced significant amounts of IgE. Anti-CD
40 stimulation of XLA B cells resulted in normal expression of CD23. I
n addition, three of the five XLA patients studied were immunized with
bacteriophage phi X174 and produced low but detectable levels of anti
phage-specific Ab, Similarly, X-linked immunodeficiency mice, which ca
rry a missense mutation in Btk, produced substantial amounts of antiph
age Ab, These results indicate that CD40 signaling is intact in B cell
s lacking demonstrable Btk, and that leaky B cells in XLA patients can
proliferate, undergo isotype switching, and differentiate into specif
ic Ab-producing cells.