Memory B cells are involved in long-term maintenance of antibody-dependent immunologic disorders. Therefore, it is essential to understand how the restimulation of FVIII-specific memory B cells in hemophilia A with FVIII inhibitors is regulated. We asked whether concurrent activation of the innate immune system by an agonist for toll-like receptor (TLR) 7 is able to facilitate the differentiation of FVIIIspecific memory B cells in the absence of T-cell help. TLR7 recognizes singlestranded RNA as contained in RNA viruses such as influenza, Sendai, and Coxsackie B viruses. Our results indicate that highly purified murine memory B cells do not differentiate into FVIII-specific antibody-secreting cells in the presence of FVIII and the TLR7 agonist when cultured in the absence of CD4 ؉ T cells. However, CD11c ؉ dendritic cells facilitate the T cell-independent differentiation of FVIII-specific memory B cells but only in the presence of FVIII and the TLR7 agonist. In contrast to T cell-dependent restimulation, the antibody response after T cell-independent restimulation of FVIIIspecific memory B cells is skewed toward IgG2a, an antibody subclass that is efficient in activating the complement system and in inducing Fc-receptormediated effector functions, both are required for effective immune responses against pathogens. (Blood. 2011;118(11): 3154-3162)
IntroductionMemory B cells are essential to maintain antibody-dependent immunologic memory that is required for long-lasting protection against invading pathogens such as viruses and bacteria. After encounter with their specific antigen, memory B cells can rapidly proliferate and differentiate into antibody-secreting plasma cells (ASCs), thereby replenishing the pool of plasma cells. 1 Moreover, memory B cells act as efficient antigen-presenting cells for the restimulation of CD4 ϩ T cells because they express high-affinity antigen receptors, major histocompatibility complex class II molecules, and costimulatory molecules. 2 However, memory B cells are also involved in long-term maintenance of immunopathologic conditions such as chronic antibody-dependent immunologic disorders, 3 which would indicate that memory B cells have to be eradicated for successful treatment of such diseases.We and others have demonstrated the presence of FVIII-specific memory B cells in the circulation of patients with FVIII inhibitors. [4][5][6] Furthermore, several studies have suggested that FVIIIspecific memory B cells are down-regulated during successful immune tolerance induction therapy in patients with hemophilia A and FVIII inhibitors. 5,6 These results indicate that FVIII-specific memory B cells might be essential for maintaining immunologic memory for antibodies against FVIII in patients. Therefore, it is important to understand the regulation of FVIII-specific memory B cells and to find new approaches to specifically eradicate these cells.We used a murine model of hemophilia A to study the regulation of FVIII-specific memory B cells in vitro. We demonstrated previously that the rest...