IntroductionImmunoglobulin (Ig), as paired heavy chain (HC) and light chain (LC), occurs in a secreted form as antibody. It also exists in a membrane form (HC ϩ LC) sheathed by the Ig␣/Ig heterodimer 1,2 forming the B-cell receptor (BCR). Here it plays a major role in B lymphocyte activation 3 and survival. 4,5 Heavy chain diseases (HCDs) are rare B-cell proliferative disorders characterized by the presence in the serum of monoclonal, incomplete, Ig HCs not associated with LCs. 6 Alterations in the Ig HC gene leading to HC molecules have been identified in HCD, with deletions in the variable (V) domain in all but one case studied to date. 7 This makes the HC gene mutation a recurrent alteration in a tumor, which tends to suggest a role in pathogenesis. Whereas much attention has been paid to the secreted form of the Ig in these diseases, it now appears that the membrane form of the truncated HC, as part of the BCR, has abnormal aggregation and signaling properties that may contribute to disease development. Here we review the current knowledge on the functions of surface HC and on the alterations of these proteins in HCD.
HCD definitionThe definition of HCD is usually a biochemical one: 8 the presence of an abnormal HC not associated with LC in the serum. However, this biochemical definition has 2 caveats: (1) there are lymphoproliferations where abnormal HCs are not secreted, although produced; 9 and (2) a biochemical alteration is not a disease by itself. In this review, we focus on HC protein alterations associated with lymphomas, whether they meet the traditional biochemical criteria or not.
Clinical features and classificationThe clinical aspects of HCD have been recently reviewed elsewhere 10 and are summarized here. ␣-HCD, 11 the most common HCD with more than 400 reported cases, 12 is almost equivalent to immunoproliferative small intestinal disease (IPSID), 13 although there are gastric and pulmonary forms of ␣-HCD, and IPSID can also be associated with ␥-HCD. IPSID, a variant of extranodal marginal zone lymphoma, is characterized by the presence of diffuse mucosal infiltrates, 14 involving a large part of the intestine, thus producing malabsorption. 15 It affects mainly younger adults in the Middle East and the Mediterranean region. Treatment of IPSID at an early phase with antibiotics causes remission in some patients, 16 which may be the result of their effects on Campilobacter jejuni, a bacterium strongly associated with IPSID. 17 ␥-HCD is a heterogeneous condition but usually presents as an aggressive form of lymphoplasmacytic lymphoma, whereas -HCD, the rarest form of HCD, typically presents as a chronic lymphocytic leukemia, frequently with vacuoles in the malignant lymphocytes, and the presence of light chains in the urine. 10 It is of interest to note that all of these B-cell proliferations, even if they have a large plasma cell component, are lymphomas rather than plasma cell proliferations. The latter are known not to require an HC for survival. 18
Functions of surface (or membrane) HCsAll...