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      Allergen-specific IgE levels and the ability of IgE-allergen complexes to cross-link determine the extent of CD23-mediated T-cell activation

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          Abstract

          Background

          CD23 mediates IgE-facilitated allergen presentation and subsequent allergen-specific T-cell activation in allergic patients.

          Objective

          We sought to investigate key factors regulating IgE-facilitated allergen presentation through CD23 and subsequent T-cell activation.

          Methods

          To study T-cell activation by free allergens and different types of IgE–Bet v 1 complexes, we used a molecular model based on monoclonal human Bet v 1–specific IgE, monomeric and oligomeric Bet v 1 allergen, an MHC-matched CD23-expressing B-cell line, and a T-cell line expressing a human Bet v 1–specific T-cell receptor. The ability to cross-link Fcε receptors of complexes consisting of either IgE and monomeric Bet v 1 or IgE and oligomeric Bet v 1 was studied in human FcεRI-expressing basophils. T-cell proliferation by monomeric or oligomeric Bet v 1, which cross-links Fcε receptors to a different extent, was studied in allergic patients’ PBMCs with and without CD23-expressing B cells.

          Results

          In our model non–cross-linking IgE–Bet v 1 monomer complexes, as well as cross-linking IgE–Bet v 1 oligomer complexes, induced T-cell activation, which was dependent on the concentration of specific IgE. However, T-cell activation by cross-linking IgE–Bet v 1 oligomer complexes was approximately 125-fold more efficient. Relevant T-cell proliferation occurred in allergic patients’ PBMCs only in the presence of B cells, and its magnitude depended on the ability of IgE–Bet v 1 complexes to cross-link CD23.

          Conclusion

          The extent of CD23-mediated T-cell activation depends on the concentration of allergen-specific IgE and the cross-linking ability of IgE-allergen complexes.

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          Most cited references44

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          Treating cat allergy with monoclonal IgG antibodies that bind allergen and prevent IgE engagement

          Acute allergic symptoms are caused by allergen-induced crosslinking of allergen-specific immunoglobulin E (IgE) bound to Fc-epsilon receptors on effector cells. Desensitization with allergen-specific immunotherapy (SIT) has been used for over a century, but the dominant protective mechanism remains unclear. One consistent observation is increased allergen-specific IgG, thought to competitively block allergen binding to IgE. Here we show that the blocking potency of the IgG response to Cat-SIT is heterogeneous. Next, using two potent, pre-selected allergen-blocking monoclonal IgG antibodies against the immunodominant cat allergen Fel d 1, we demonstrate that increasing the IgG/IgE ratio reduces the allergic response in mice and in cat-allergic patients: a single dose of blocking IgG reduces clinical symptoms in response to nasal provocation (ANCOVA, p = 0.0003), with a magnitude observed at day 8 similar to that reported with years of conventional SIT. This study suggests that simply augmenting the blocking IgG/IgE ratio may reverse allergy.
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            Blocking antibodies induced by specific allergy vaccination prevent the activation of CD4+ T cells by inhibiting serum-IgE-facilitated allergen presentation.

            Allergen-specific CD4+ T lymphocytes are activated at extremely low allergen concentrations in vivo as a result of serum-facilitated allergen presentation (S-FAP). It is not clear at present if specific allergy vaccination (SAV) has an effect on this mechanism. Here we show that birch allergen-specific serum-IgE facilitates the presentation of Bet v 1, the major birch pollen allergen, to Bet v 1-specific CD4+ T lymphocytes by a factor of >100. This process is CD23 mediated, could be detected in sera from the majority of birch-allergic patients, and was clearly dose dependent. S-FAP of Bet v 1 was inhibited in patients undergoing long-term birch SAV, but not by sera from patients undergoing grass SAV, indicating that birch-specific Abs are involved. This resulted in decreased proliferation and IL-4, IL-5, IL-10, and IFN-gamma production of Bet v 1-specific T cells. The inhibition was already noted after 3-9 mo of SAV and could not be solely explained by increased serum levels of birch-specific IgG4. When IgG- and IgA/IgM-containing fractions of long-term SAV sera were used to inhibit S-FAP, only IgG-containing fractions were shown to inhibit S-FAP. These results indicate that blocking IgG Abs induced by SAV inhibits the occurrence of S-FAP at very low allergen concentrations, resulting in significantly higher allergen threshold levels to obtain T cell proliferation and cytokine production and thus allergen-induced late-phase responses.
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              The IgE-facilitated allergen binding (FAB) assay: validation of a novel flow-cytometric based method for the detection of inhibitory antibody responses.

              The IgE-facilitated allergen binding (IgE-FAB) assay represents an in vitro model of facilitated allergen presentation. Allergen-IgE complexes are incubated with an EBV-transformed B cell line and complexes bound to CD23 on the surface of cells are detected by flow cytometry. The addition of serum from patients who have received allergen-specific immunotherapy has been shown previously to inhibit allergen-IgE complex binding to CD23 on B cells. In this study, we describe the characterisation and analytical validation of the grass pollen-specific IgE-FAB assay according to guidelines from the International Conference on Harmonisation. We established the intra- and inter-assay variability of IgE-FAB and have defined the detection limits of this assay. We have also demonstrated assay linearity and robustness. Using the results from a randomised double-blind placebo-controlled trial of grass pollen immunotherapy (n=33), we have defined the clinical sensitivity and specificity of the IgE-FAB assay using ROC curve analysis. In conclusion, the IgE-FAB assay is reproducible, robust, sensitive and a specific method suitable as a tool for monitoring inhibitory antibody function from patients receiving allergen immunotherapy.
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                Author and article information

                Journal
                1275002
                J Allergy Clin Immunol
                J. Allergy Clin. Immunol.
                The Journal of allergy and clinical immunology
                0091-6749
                1097-6825
                24 November 2019
                24 November 2019
                21 January 2020
                30 March 2020
                : 145
                : 3
                : 958-967.e5
                Affiliations
                [a ]Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
                [b ]Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
                [c ]Institute of Molecular Biosciences, BioTechMed Graz, University of Graz, Graz, Austria
                [d ]Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
                [e ]Department for Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
                [f ]Division of Medical Biotechnology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
                [g ]Division of Medicinal Safety Science, National Institute of Health Sciences, Kanagawa, Japan
                [h ]Institute of Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
                [i ]Laboratory of Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russia
                [j ]NRC Institute of Immunology FMBA of Russia, Moscow, Russia
                Author notes
                Corresponding author: Julia Eckl-Dorna, MD, PhD, Department of Otorhinolaryngology, Research laboratories 8H, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. julia.eckl-dorna@ 123456meduniwien.ac.at .
                Article
                EMS85539
                10.1016/j.jaci.2019.11.019
                7104374
                31775017
                c6081e59-9376-4043-8daa-c296004a5eac

                This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Categories
                Article

                Immunology
                allergen,cd23,bet v 1,facilitated allergen presentation,ige,birch pollen allergy,cross-linking,t-cell activation,ige-allergen complex

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