A novel splice variant of FcγRIIa: A risk factor for anaphylaxis in patients with hypogammaglobulinemia  Joris van der Heijden, MSc, Judy Geissler, Edwin.

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A novel splice variant of FcγRIIa: A risk factor for anaphylaxis in patients with hypogammaglobulinemia  Joris van der Heijden, MSc, Judy Geissler, Edwin van Mirre, PhD, Marcel van Deuren, MD, PhD, Jos W.M. van der Meer, MD, PhD, Abdulgabar Salama, MD, PhD, Timo K. van den Berg, PhD, Dirk Roos, PhD, Taco W. Kuijpers, MD, PhD  Journal of Allergy and Clinical Immunology  Volume 131, Issue 5, Pages 1408-1416.e5 (May 2013) DOI: 10.1016/j.jaci.2013.02.009 Copyright © 2013 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 Melting curves and gel electrophoresis of FcγRII isoforms in the CVID family. A, upper panels, A shift to the right in the melting curves of the patient (red lines) and her brother (blue lines) is observed for the FcγRIIa PCR product but not for the FcγRIIb2 PCR product. Duplicates of the patient and her brother are indicated by dashed lines. Melting curves of all other tested subjects are indicated in black. B, Analysis of the PCR products on agarose gel. The leftmost lanes contain markers. Lane 1, A healthy nonrelated control subject; lane 2, a nontemplate control subject; lane 3, a patient with CVID; lane 4, mother; lane 5, and brother. Journal of Allergy and Clinical Immunology 2013 131, 1408-1416.e5DOI: (10.1016/j.jaci.2013.02.009) Copyright © 2013 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 Site of point mutation in the genome. A, An overview of the genomic organization of FCGR2, in which blocks represent exons and lines indicate introns. TM, Transmembrane domain. Exon 6* is hatched where it is spliced out. Retention of exon 6* is linked to the +871 point mutation in intron 5, as shown by the arrow. B, Pedigree of the index patient with CVID, including her healthy father and brother carrying the same FCGR2Ac.742+871A>G allele. Journal of Allergy and Clinical Immunology 2013 131, 1408-1416.e5DOI: (10.1016/j.jaci.2013.02.009) Copyright © 2013 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 3 SDS-PAGE and Western blot of FcγRIIa and FcγRIIaexon6∗. Neutrophil lysates were obtained, as described in the Methods section, and run on a 10% (wt/vol) Bis-Tris gel. Thereafter, the proteins were blotted on a polyvinylidene difluoride membrane, which was probed with a polyclonal antibody against the cytoplasmic tail of FcγRIIa. Lane 1, Patient with CVID; lane 2, father of the patient with CVID; lane 3, healthy control subject not expressing FcγRIIaexon6∗. Journal of Allergy and Clinical Immunology 2013 131, 1408-1416.e5DOI: (10.1016/j.jaci.2013.02.009) Copyright © 2013 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 4 Neutrophils expressing FcγRIIaexon6∗ respond more vigorously to dimeric IgG. Elastase release from neutrophils of subjects expressing FcγRIIa with (n = 4) or without (n = 14) exon 6*. Neutrophils were stimulated with dimeric IgG in the presence or absence of blocking Fab (IV.3, anti-FcγRII) fragments or with fMLP/cytochalasin B (CytoB). The difference in the response to dimeric IgG is statistically significant in the absence (P = .0077) and presence (P < .0001) of blocking Fab fragments in contrast to the response to fMLP/CytoB (P = .7, not significant). ∗∗P between .001 and .01; ∗∗∗P < .001. Journal of Allergy and Clinical Immunology 2013 131, 1408-1416.e5DOI: (10.1016/j.jaci.2013.02.009) Copyright © 2013 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 5 Increased [Ca2+]i levels in IIA1.6 cells transfected with FcγRIIaexon6∗ after receptor cross-linking. IIA1.6 cells were transfected with either FcγRIIa (solid line and arrows) or FcγRIIaexon6∗ (dashed line and arrows), and these receptors were cross-linked. A, Representative [Ca2+]i traces from 1 experiment. Arrows indicate addition of goat anti-mouse IgG or thapsigargin (after [Ca2+]i stabilization). The experiment shown was repeated 6 times with identical results. B, Combined data from all experiments. All values are response peak levels minus baseline levels. Differences were significant in the case of FcγR cross-linking (P < .03, n = 6) but not in case of thapsigargin (P = .7 [not significant], n = 6). ∗P between .01 and .05. Journal of Allergy and Clinical Immunology 2013 131, 1408-1416.e5DOI: (10.1016/j.jaci.2013.02.009) Copyright © 2013 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E1 Alignment of FCGR2A, FCGR2B, FCGR2C, and exon 6* of FCGR2A. Exon 6/6* sequences of FCGR2A (wild-type), FCGR2B, and FCGR2C and of the exon 6*–containing transcript, as indicated by “exon 6*”, are depicted in the gray box. Sequences outside the gray box represent part of intron 5/6 of the 3 genomic sequences. Nucleotide differences are indicated by asterisks. Underlined are the nucleotides that are found in FCGR2A and the exon 6*–containing transcript but not in FCGR2B and FCGR2C. SNPs are enclosed by parentheses. Journal of Allergy and Clinical Immunology 2013 131, 1408-1416.e5DOI: (10.1016/j.jaci.2013.02.009) Copyright © 2013 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E2 FcγRIIa and FcγRIIaexon6∗ expression levels on neutrophils. Data are shown as the mean fluorescence intensity (MFI) of fluorescently labeled mAbs against FcγRII (AT10). No significant difference (NS) was found between neutrophils expressing FcγRIIa and FcγRIIaexon6∗ (P = .9859). Values were corrected by subtracting the background values measured with isotype mAb controls. Data are expressed as means ± SEMs of 3 experiments. Journal of Allergy and Clinical Immunology 2013 131, 1408-1416.e5DOI: (10.1016/j.jaci.2013.02.009) Copyright © 2013 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E3 Pedigrees of 2 families with KD showing inheritance of FcγRIIa containing exon 6*. Pedigrees of 2 families with KD are indicated, showing autosomal inheritance of FcγRIIa containing exon 6*. Journal of Allergy and Clinical Immunology 2013 131, 1408-1416.e5DOI: (10.1016/j.jaci.2013.02.009) Copyright © 2013 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E4 FcγRIIa and FcγRIIaexon6∗ expression levels on transfected IIA1.6 cells. Data are shown as the mean fluorescence intensity (MFI) of fluorescently labeled mAbs against FcγRII (AT10). No significant difference (NS) was found between cells transfected with FcγRIIa and FcγRIIaexon6∗ (P = .39). Values were corrected by subtracting the background values measured with isotype mAb controls. Data are expressed as means ± SEMs of 6 experiments. Journal of Allergy and Clinical Immunology 2013 131, 1408-1416.e5DOI: (10.1016/j.jaci.2013.02.009) Copyright © 2013 American Academy of Allergy, Asthma & Immunology Terms and Conditions