A restricted clonal T-cell receptor alpha beta repertoire in Sezary syndrome is indicative of superantigenic stimulation

Background Sezary syndrome (SS) is a cutaneous T-cell lymphoma characterized by erythroderma, lymphadenopathy and malignant clonal T cells in the skin, lymph nodes and peripheral blood. A role for superantigens in the pathogenesis of SS has been postulated before. Objectives To investigate a putative involvement of chronic (super-) antigenic stimulation in driving T-cell expansion in SS. Methods Antigenic specificity of the T-cell receptor (TCR) was assayed by molecular analysis of the TCRA (n = 11) and TCRB (n = 28) genes, followed by detailed in silico analysis. Results Sequence analysis of clonally rearranged TCRB genes showed over-representation of V beta 8, V beta 13, V beta 17, V beta 21 and V beta 22, and under-representation of V beta 2 and J beta 1.1 when compared with healthy controls. No similarity was detected in amino acid motifs of the complementarity determining region 3 (CDR3). Analysis of TCRA rearrangements showed that there was no common V alpha or J alpha gene usage, and that TCRA CDR3 amino acid motifs were not highly similar. Conclusions The lack of clear stereotypic TCRA and TCRB CDR3 amino acid motifs would argue against involvement of a single common antigen in the pathogenesis of SS. Nevertheless, the skewing of V beta and J beta gene usage does seem to point to a restricted TCR repertoire, possibly as a result of superantigenic selection prior to neoplastic transformation.