Evidence of B Cell Clonality and Investigation Into Properties of the IgM in Patients With Schnitzler Syndrome

Shelly Pathak, Dorota Rowczenio, Samuel Lara-Reyna, Mark Kacar, Roger Owen, Gina Doody, Karoline Krause, Helen Lachmann, Rainer Doffinger, Darren Newton, Sinisa Savic

Research output: Contribution to journalArticlepeer-review


The Schnitzler Syndrome (SchS) is an acquired, autoinflammatory condition successfully treated with IL-1 inhibition. The two main defining features of this late-onset condition are neutrophilic urticarial dermatoses (NUD) and the presence of an IgM monoclonal component. While the former aspect has been extensively studied in this disease setting, the enigmatic paraproteinaemia and its potential consequential effects within SchS, has not previously been thoroughly addressed. Previous studies analyzing clonal B cell repertoires have largely focused on autoimmune disorders such as Systemic Lupus Erythematous (SLE) and hematological malignancies such as Chronic Lymphocytic Leukaemia (CLL), where B-cell clonality is central to disease pathology. The present study uses next-generation sequencing to provide detailed insight into aspects of B cell VDJ recombination and properties of the resulting immunoglobulin chains. An overview of IgH regional dynamics in 10 SchS patients, with a particular focus on CDR3 sequences and VDJ gene usage is reported, highlighting the presence of specific B cell expansions. Protein microarray detected a substantial proportion of autoreactive IgM to nuclear target proteins, though a single universal target was not identified. Together, these genetic and functional findings impart new understanding into this rare disorder.

Original languageEnglish
Pages (from-to)569006
JournalFrontiers in immunology
Publication statusPublished - 2020

Bibliographical note

Copyright © 2020 Pathak, Rowczenio, Lara-Reyna, Kacar, Owen, Doody, Krause, Lachmann, Doffinger, Newton and Savic.


  • Adult
  • Alleles
  • B-Lymphocytes/immunology
  • Biomarkers
  • Carrier Proteins/metabolism
  • Clonal Evolution/genetics
  • Disease Susceptibility/immunology
  • Female
  • Genetic Predisposition to Disease
  • Genetic Variation
  • Humans
  • Immunoglobulin Heavy Chains/genetics
  • Immunoglobulin M/genetics
  • Male
  • Middle Aged
  • Phenotype
  • Protein Binding/immunology
  • Proteome
  • Proteomics/methods
  • Schnitzler Syndrome/diagnosis
  • V(D)J Recombination


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