- Csomos, Krisztian;
- Ujhazi, Boglarka;
- Blazso, Peter;
- Herrera, Jose L;
- Tipton, Christopher M;
- Kawai, Tomoki;
- Gordon, Sumai;
- Ellison, Maryssa;
- Wu, Kevin;
- Stowell, Matthew;
- Haynes, Lauren;
- Cruz, Rachel;
- Zakota, Bence;
- Nguyen, Johnny;
- Altrich, Michelle;
- Geier, Christoph B;
- Sharapova, Svetlana;
- Dasso, Joseph F;
- Leiding, Jennifer W;
- Smith, Grace;
- Al-Herz, Waleed;
- de Barros Dorna, Mayra;
- Fadugba, Olajumoke;
- Fronkova, Eva;
- Kanderova, Veronika;
- Svaton, Michael;
- Henrickson, Sarah E;
- Hernandez, Joseph D;
- Kuijpers, Taco;
- Kandilarova, Snezhina Mihailova;
- Naumova, Elizaveta;
- Milota, Tomas;
- Sediva, Anna;
- Moshous, Despina;
- Neven, Benedicte;
- Saco, Tara;
- Sargur, Ravishankar;
- Savic, Sinisa;
- Sleasman, John;
- Sunkersett, Gauri;
- Ward, Brant R;
- Komatsu, Masanobu;
- Pittaluga, Stefania;
- Kumanovics, Attila;
- Butte, Manish J;
- Cancro, Michael P;
- Pillai, Shiv;
- Meffre, Eric;
- Notarangelo, Luigi D;
- Walter, Jolan E
The recombination-activating genes (RAG) 1 and 2 are indispensable for diversifying the primary B cell receptor repertoire and pruning self-reactive clones via receptor editing in the bone marrow; however, the impact of RAG1/RAG2 on peripheral tolerance is unknown. Partial RAG deficiency (pRD) manifesting with late-onset immune dysregulation represents an 'experiment of nature' to explore this conundrum. By studying B cell development and subset-specific repertoires in pRD, we demonstrate that reduced RAG activity impinges on peripheral tolerance through the generation of a restricted primary B cell repertoire, persistent antigenic stimulation and an inflammatory milieu with elevated B cell-activating factor. This unique environment gradually provokes profound B cell dysregulation with widespread activation, remarkable extrafollicular maturation and persistence, expansion and somatic diversification of self-reactive clones. Through the model of pRD, we reveal a RAG-dependent 'domino effect' that impacts stringency of tolerance and B cell fate in the periphery.