tretinoin and Waldenstrom-Macroglobulinemia

Monoclonal IgM associated with a peripheral neuropathy often feature an antibody activity directed against the myelin-associated-glycoprotein. The main characteristics of the structure of these IgM are reviewed: the variable gene repertoire used by these antibodies is rather large. The VH genes belong to the different variability subgroups; this also holds true for the VL repertoire although the single V kappa 4 gene may be used quite often. These variable segments often exhibit somatic mutations clustered in the CDR regions suggesting an antigen driven process. The monoclonal IgM is produced by a B cell clone which may be undetectable in the majority of patients. Nevertheless, it is possible to detect clonal B cells in the blood which have the remarkable capacity to differentiate spontaneously in vitro to plasma cells. This process is dependent upon an IL6-autocrine differentiation pathway which may be modulated by some drugs such as interferons or all trans retinoic acid.

Topics: Antibodies, Monoclonal; B-Lymphocytes; Cell Differentiation; Humans; Immunoglobulin M; Interferons; Peripheral Nervous System Diseases; Plasma Cells; Tretinoin; Waldenstrom Macroglobulinemia

We previously showed that clonal blood B cells from patients with macroglobulinemia spontaneously differentiate in vitro to plasma cells. This process is dependent on an interleukin (IL)-6 autocrine pathway. We investigate here whether all-trans-retinoic acid (RA) interferes with B-cell differentiation either in patients with IgM gammapathy of undetermined significance (MGUS) or Waldenström's macroglobulinemia (WM). RA at a concentration of 10(-5) to 10(-8) mol/L inhibited by 50% to 80% the in vitro differentiation of purified B cells from four of five patients with MGUS and from one of five patients with WM as assessed by the IgM content of day 7 culture supernatants. We next determined whether this effect could be related to an inhibition of IL-6 secretion by cultured B cells and/or a downregulation of the IL-6 receptor (IL-6R), which was constitutively expressed on patients' blood B cells. A 50% to 100% (mean, 80%) inhibition of IL-6 production was found in seven of 10 patients (five with MGUS and two with WM). The IL-6R was no more detectable on cells from patients with MGUS after 2 days of treatment with RA and slightly downregulated in patients with WM. It was of interest that B cells susceptible to the action of RA belonged mostly to patients with IgM MGUS, which reinforces our previous data showing distinct requirements for IL-6-dependent differentiation of blood B cells from patients with VM or IgM MGUS.

Topics: B-Lymphocytes; Cell Differentiation; Cells, Cultured; Humans; Interleukin-6; Receptors, Interleukin; Receptors, Interleukin-6; Tretinoin; Waldenstrom Macroglobulinemia