Hyper-
immunoglobulin M syndrome is an X-linked
primary immunodeficiency disease caused by mutations in the
CD40 ligand gene. The
CD40 ligand has been recently highlighted as playing a key role in the pathogenesis of
primary biliary cholangitis. In the present study, we assessed an extensive set of serum
autoantibodies in a series of well-defined patients with hyper-
immunoglobulin M syndrome. Serum, liver-related and liver-not-related
autoantibodies IgG,
IgM and
IgA were tested by ELISA and standard indirect immunofluorescence in HEp-2 cells in 13 Tunisian patients (8 males and 5 females, aged 1-12 years) with hyper-
immunoglobulin M syndrome during 1995-2012 and, as controls, 21 age- and gender-matched blood donors. The level of
IgM antibody against MIT3 was significantly higher in patients than in controls (35.8 vs 10.7, P=0.002). Half of the hyperimmunoglobulin
M syndrome patients were found to be anti-MIT3
IgM positive vs none of the controls (P<0.0001). Twenty-three percent of patients were found to be anti-sp100 antibody positive vs only 0.05% of controls. By immunofluorescence, 92.3% of patients were MIT3
IgM positive vs none of the controls. In conclusion, the
IgM class of anti-MIT3
antibodies was shown to be present by both ELISA and immunofluorescence in most of the patients with hyper-
immunoglobulin M syndrome. The presence of the hallmark of
primary biliary cholangitis, a disease where the
CD40 ligand is a key player, in an immunodeficiency disease caused by mutations in the
CD40 ligand gene is very intriguing and opens new scenarios in understanding the immune pathogenesis of
primary biliary cholangitis.