Turk J Immunol. 2023; 11(1): 29-36 | DOI: 10.4274/tji.galenos.2023.36854

Classification of Common Variable Immunodeficiency Using Measurement of B-cell Subsets in Moroccan Patients

Khaoula Mokhantar¹, Allaoui Abire², Fatima Ailal³, Jalila El Bakkouri⁴, Kaoutar Ouazahrou¹, Abderrahmane Errami¹, Ahmed Aziz Bousfiha³, Mina Moudatir^5
1Laboratory of Clinical Immunology, Inflammation, and Allergy (LICIA), Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
²Laboratory of Clinical Immunology, Inflammation, and Allergy (LICIA), Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco and Department of Internal Medicine, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, Morocco
³Laboratory of Clinical Immunology, Inflammation, and Allergy (LICIA), Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco and Department of Pediatric Infectious and Immunological Diseases, Abderrahim El Harouchi Mother-Child Hospital, University Hospital Center Ibn Rochd, Hassan II University, Casablanca, Morocco
⁴Laboratory of Clinical Immunology, Inflammation, and Allergy (LICIA), Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco and Immunology Laboratory, University Hospital Center Ibn Rochd, Hassan II University, Casablanca, Morocco
⁵Laboratory of Clinical Immunology, Inflammation, and Allergy (LICIA), Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco and Department of Internal Medicine, University Hospital Center Ibn Rochd, Hassan II University, Casablanca, Morocco

Objective: Common variable immunodeficiency (CVID) is a complex inborn error of humoral immunity with complications of infectious and non-infectious origins. Classifications of CVID patients provide a clearer understanding of the pathogenesis, prediction, and management of non-infectious complications. This study aimed to classify Moroccan CVID patients using B-cell immunophenotyping, based on the European classification (EUROclass).
Materials and Methods: We recruited 20 CVID patients fullfilling established diagnostic standards. After collecting clinical and demographic data, we analyzed B-cell subsets by flow cytometry, grouped patients, and assessed the relationship of each group with clinical manifestations.
Results: In our cohort, 90% of the patients had a clinical history of respiratory infections. The non-infectious manifestations included splenomegaly, autoimmunity, lymphadenopathy, and granulomatous diseases diagnosed in 50%, 45%, 40%, and 25% of patients, respectively. We observed significant co-occurrence of splenomegaly with autoimmunity and to a lesser extent with granulomatous diseases. Patients had a significant reduction in total, switched memory, marginal zone-like, and plasmablasts, along with a strong increase in the percentage of activated B-cells, suggesting a defect in the late phases of B-cell differentiation. This condition was linked with an increased occurrence of splenomegaly and granulomatous affections. Besides, patients had also an expansion of CD21low B-cells, which was strongly associated with splenomegaly.
Conclusion: The classification of the first Moroccan cohort of CVID patients showed agreement with previous results. It suggests the possibility of adopting this approach on a global scale for better diagnosis and follow-up of CVID patients.

Keywords: B-cell subsets, common variable immunodeficiency, flow cytometry, hypogammaglobulinemia

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