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B‐Cell Activation in Duodenal Mucosa after Oral Cholera Vaccination in IgA Deficient Subjects with or without IgG Subclass Deficiency

Alterations in duodenal Ig‐producing cells induced by two oral cholera vaccinations were studied by two‐colour immunofluorescence in mucosal tissue sections from adults with selective IgA deficiency (IgAD), cither with (n= 7) or without (n= 9) frequent infections, infection‐prone patients with combined IgAD and IgG subclass deficiency (IgGSD) (n= 7), and normal control subjects (n= 11). The proportion of IgG‐producing cells prior to immunization tended to be lower in the symptomatic IgAD subjects than in the clinically healthy ones. In the first subgroup the absolute number of IgG cells per intestinal length unit was significantly increased after immunization (P < 0.04), and this tendency was also observed in the healthy IgAD subjects (6/9) and in those with combined deficiency (5/7). Very few IgAD subjects responded with an increase of IgM‐producing cells. The normal controls responded variably in all major immunocyte classes, in the order IgA > IgG > IgM. Compared with these controls, the patients with combined IgAD and IgGSD showed significantly increased IgG1 (P < 0.01) and reduced IgG2(P < 0.006) proportions, which was in accordance with their serum subclass levels. Our study showed that oral cholera vaccination preferentially activates intestinal IgG‐producing cells in IgAD subjects. This result agreed with data recently obtained by ELISPOT in the same patients with regard to antibody‐forming cells specific for cholera toxin. Both methods suggested that IgG rather than IgM antibodies are elicited as compensation for a lacking IgA response. However, our overall results showed that intestinal B‐cell activation is quite variable after oral cholera vaccination. Although such vaccination might be of importance for enhancing mucosal immunity also in IgAD patients, a concurrent gut disease could possibly be aggravated by IgG‐mediated mucosal immunopathology in the absence of anti‐inflammatory IgA antibodies.