This study was approved by the institutional review board at Sheba Medical Center, and informed written consent was obtained from all participating subjects.
1. DNA isolation and quantification
<ol>
	<li>Digestion and cell lysis of intestinal biopsies
	<ol>
		<li>Retrieve intestinal biopsies, either freshly collected or those stored at -20 &#176;C or -80 &#176;C. If using frozen biopsies, thaw on ice.</li>
		<li>Add 600 &#181;L of nuclei lysis solution to a sterile 1.7 mL micro-centrifuge tu...

<ol>
	<li>Bassing, C. H., Swat, W., Alt, F. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+mechanism+and+regulation+of+chromosomal+V(D)J+recombination.">The mechanism and regulation of chromosomal V(D)J recombination.</a> Cell. 109, 45-55 (2002).</li><li>Roth, D. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=V(D)J+Recombination:+Mechanism,+Errors,+and+Fidelity.">V(D)J Recombination: Mechanism, Errors, and Fidelity.</a> Microbiology Spectrum. 2 (6), (2014).</li><li>Heather, J. M., Ismail, M., Oakes, T., Chain, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=High-throughput+sequencing+of+the+T-cell+receptor+repertoire:+pitfalls+and+opportunities.">High-throughput sequencing of the T-cell receptor repertoire: pitfalls and opportunities.</a> Brief Bioinformatics. 19 (4), 554-565 (2018).</li><li>Pabst, O., Hazanov, H., Mehr, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Old+questions,+new+tools:+does+next-generation+sequencing+hold+the+key+to+unraveling+intestinal+B-cell+responses.">Old questions, new tools: does next-generation sequencing hold the key to unraveling intestinal B-cell responses.</a> Mucosal Immunology. 8 (1), 29-37 (2015).</li><li>Bashford-Rogers, R. J. M., Smith, K. G. C., Thomas, D. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Antibody+repertoire+analysis+in+polygenic+autoimmune+diseases.">Antibody repertoire analysis in polygenic autoimmune diseases.</a> Immunology. 155 (1), 3-17 (2018).</li><li>Lee, Y. N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Characterization+of+T+and+B+cell+repertoire+diversity+in+patients+with+RAG+deficiency.">Characterization of T and B cell repertoire diversity in patients with RAG deficiency.</a> Science Immunology. 1 (6), (2016).</li><li>Werner, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Alterations+in+T+and+B+Cell+Receptor+Repertoires+Patterns+in+Patients+With+IL10+Signaling+Defects+and+History+of+Infantile-Onset+IBD.">Alterations in T and B Cell Receptor Repertoires Patterns in Patients With IL10 Signaling Defects and History of Infantile-Onset IBD.</a> Frontiers Immunology. 11, 109 (2020).</li><li>Zhang, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Immune+receptor+repertoires+in+pediatric+and+adult+acute+myeloid+leukemia.">Immune receptor repertoires in pediatric and adult acute myeloid leukemia.</a> Genome Medicine. 11 (1), 73 (2019).</li><li>Chapman, C. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Characterization+of+T-cell+Receptor+Repertoire+in+Inflamed+Tissues+of+Patients+with+Crohn's+Disease+Through+Deep+Sequencing.">Characterization of T-cell Receptor Repertoire in Inflamed Tissues of Patients with Crohn's Disease Through Deep Sequencing.</a> Inflammatory Bowel Diseases. 22 (6), 1275-1285 (2016).</li><li>Werner, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Altered+T+cell+receptor+beta+repertoire+patterns+in+pediatric+ulcerative+colitis.">Altered T cell receptor beta repertoire patterns in pediatric ulcerative colitis.</a> Clinical and Experimental Immunology. 196 (1), 1-11 (2019).</li><li>Bashford-Rogers, R. J. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Analysis+of+the+B+cell+receptor+repertoire+in+six+immune-mediated+diseases.">Analysis of the B cell receptor repertoire in six immune-mediated diseases.</a> Nature. 574 (7776), 122-126 (2019).</li><li>Wu, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Expanded+TCRbeta+CDR3+clonotypes+distinguish+Crohn's+disease+and+ulcerative+colitis+patients.">Expanded TCRbeta CDR3 clonotypes distinguish Crohn's disease and ulcerative colitis patients.</a> Mucosal Immunology. 11 (5), 1487-1495 (2018).</li><li>Rosati, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Identification+of+disease-associated+traits+and+clonotypes+in+the+T-cell+receptor+repertoire+of+monozygotic+twins+affected+by+inflammatory+bowel+diseases.">Identification of disease-associated traits and clonotypes in the T-cell receptor repertoire of monozygotic twins affected by inflammatory bowel diseases.</a> Journam of Crohn's and Colitis. , (2019).</li><li>Allez, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=T+cell+clonal+expansions+in+ileal+Crohn's+disease+are+associated+with+smoking+behaviour+and+postoperative+recurrence.">T cell clonal expansions in ileal Crohn's disease are associated with smoking behaviour and postoperative recurrence.</a> Gut. 68 (11), 1961-1970 (2019).</li><li>Li, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=IMGT/HighV+QUEST+paradigm+for+T+cell+receptor+IMGT+clonotype+diversity+and+next+generation+repertoire+immunoprofiling.">IMGT/HighV QUEST paradigm for T cell receptor IMGT clonotype diversity and next generation repertoire immunoprofiling.</a> Nature Communications. 4, 2333 (2013).</li><li>H, I. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Strategies+for+B-cell+receptor+repertoire+analysis+in+primary+immunodeficiencies:+from+severe+combined+immunodeficiency+to+common+variable+immunodeficiency.">Strategies for B-cell receptor repertoire analysis in primary immunodeficiencies: from severe combined immunodeficiency to common variable immunodeficiency.</a> Frontiers Immunology. 6, 157 (2015).</li><li>Ghraichy, M., Galson, J. D., Kelly, D. F., Truck, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=B-cell+receptor+repertoire+sequencing+in+patients+with+primary+immunodeficiency:+a+review.">B-cell receptor repertoire sequencing in patients with primary immunodeficiency: a review.</a> Immunology. 153 (2), 145-160 (2018).</li><li>Zhuang, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Application+of+immune+repertoire+sequencing+in+cancer+immunotherapy.">Application of immune repertoire sequencing in cancer immunotherapy.</a> International Immunopharmacology. 74, 105688 (2019).</li><li>Liu, X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=T+cell+receptor+beta+repertoires+as+novel+diagnostic+markers+for+systemic+lupus+erythematosus+and+rheumatoid+arthritis.">T cell receptor beta repertoires as novel diagnostic markers for systemic lupus erythematosus and rheumatoid arthritis.</a> Annual Rheumatic Diseases. 78 (8), 1070-1078 (2019).</li><li>Wong, G. K., Heather, J. M., Barmettler, S., Cobbold, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Immune+dysregulation+in+immunodeficiency+disorders:+The+role+of+T-cell+receptor+sequencing.">Immune dysregulation in immunodeficiency disorders: The role of T-cell receptor sequencing.</a> Journal of Autoimmunity. 80, 1-9 (2017).</li><li>Delhalle, S., Bode, S. F. N., Balling, R., Ollert, M., He, F. Q. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+roadmap+towards+personalized+immunology.">A roadmap towards personalized immunology.</a> NPJ System Biology and Applications. 4, 9 (2018).</li><li>Laubli, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+T+cell+repertoire+in+tumors+overlaps+with+pulmonary+inflammatory+lesions+in+patients+treated+with+checkpoint+inhibitors.">The T cell repertoire in tumors overlaps with pulmonary inflammatory lesions in patients treated with checkpoint inhibitors.</a> Oncoimmunology. 7 (2), 1386962 (2018).</li><li>Hogan, S. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Peripheral+Blood+TCR+Repertoire+Profiling+May+Facilitate+Patient+Stratification+for+Immunotherapy+against+Melanoma.">Peripheral Blood TCR Repertoire Profiling May Facilitate Patient Stratification for Immunotherapy against Melanoma.</a> Cancer Immunology Research. 7 (1), 77-85 (2019).</li><li>Aversa, I., Malanga, D., Fiume, G., Palmieri, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Molecular+T-Cell+Repertoire+Analysis+as+Source+of+Prognostic+and+Predictive+Biomarkers+for+Checkpoint+Blockade+Immunotherapy.">Molecular T-Cell Repertoire Analysis as Source of Prognostic and Predictive Biomarkers for Checkpoint Blockade Immunotherapy.</a> International Journal of Molecular Sciences. 21 (7), (2020).</li><li>Hirsch, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Precision+and+prognostic+value+of+clone-specific+minimal+residual+disease+in+acute+myeloid+leukemia.">Precision and prognostic value of clone-specific minimal residual disease in acute myeloid leukemia.</a> Haematologica. 102 (7), 1227-1237 (2017).</li><li>De Simone, M., Rossetti, G., Pagani, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Single+Cell+T+Cell+Receptor+Sequencing:+Techniques+and+Future+Challenges.">Single Cell T Cell Receptor Sequencing: Techniques and Future Challenges.</a> Frontiers Immunology. 9, 1638 (2018).</li><li>Zemmour, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Single-cell+gene+expression+reveals+a+landscape+of+regulatory+T+cell+phenotypes+shaped+by+the+TCR.">Single-cell gene expression reveals a landscape of regulatory T cell phenotypes shaped by the TCR.</a> Nature Immunology. 19 (3), 291-301 (2018).</li><li>Zheng, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Landscape+of+Infiltrating+T+Cells+in+Liver+Cancer+Revealed+by+Single-Cell+Sequencing.">Landscape of Infiltrating T Cells in Liver Cancer Revealed by Single-Cell Sequencing.</a> Cell. 169 (7), 1342-1356 (2017).</li></ol>

All authors have nothing to disclose.

Changes in abundance and function of B and T lymphocytes are often encountered in different malignancies18, chronic inflammatory disorders (e.g., ulcerative colitis and rheumatoid arthritis)10,19, and in various immunodeficiencies17,20. The current method utilizes NGS to facilitate an in-depth view of TCR and BCR repertoires, enabling detection of subtle changes in T and B cell clo...

The adaptive immune system, comprised of T and B lymphocytes, utilizes immunological memory to recognize a previously encountered antigen and initiate a rapid response. Lymphocytes are generated in the bone marrow and mature in the thymus (T cells) or bone marrow (B cells). Both the T cell receptor (TCR) and B cell receptor (BCR) display unique configurations that allow recognition of specific antigens. In homeostasis, T and B cells constantly circulate and survey the trillions of different peptides presented on antigen-presenting cells. TCR or BCR ligation of a specific antigen with high affinity, together with appropriate co-stimulation, leads to cell activation, resulting in cytokine secretion, clonal expansion and generation of antibodies, in the case of B cells.
The enormous array of the different T or B cells is collectively termed immune repertoire, enabling recognition of countless of different epitopes. In order to generate such a vast repertoire, a complex process of random assembly of different gene segments takes place, creating nearly endless combinations of receptors that can bind unique antigens1. This process, called V(D)J recombination, includes rearrangements of different variable (V), diversity (D) and joining (J) genes, accompanied by random deletions and insertions of nucleotides in the junctions2.
The architecture of the adaptive immune system has interested scientists in different fields for many decades. In the past, Sanger sequencing, complementary determining region 3 (CDR3) spectratyping, and flow cytometry were used to characterize the immune repertoire, but provided low resolution. In the last decade, advances in next-generation sequencing (NGS) methods enabled in-depth insight into the characteristics and composition of an individual&#8217;s TCR and BCR repertoires3,4. These high-throughput systems (HTS) sequence and process millions of rearranged TCR or BCR products simultaneously and permit a high-resolution analysis of specific T and B cells at the nucleotide or amino acid level. NGS provides a new strategy to study the immune repertoire in both health and disease. Studies utilizing HTS demonstrated altered TCR and BCR repertoires in autoimmune diseases5, primary immunodeficiencies6,7, and malignancies, such as in acute myeloid leukemia8. Using NGS, we and others have shown oligoclonal expansion of specific T and B cell clones, in patients with inflammatory bowel disease (IBD), including ulcerative colitis and Crohn&#8217;s disease9,10,11,12,13,14. Overall, studies from different fields suggest changes in the repertoire have a crucial role in the pathogenesis of immune-mediated disorders.
The current protocol describes a method for isolation of DNA from intestinal biopsies and blood, generation of TCR&#946; and IGH PCR libraries for NGS, and performance of sequencing run. We also provide basic steps in immune repertoire data analysis. This protocol can be applied for the generation of TCR&#945;, TCR&#947;, and IGL libraries as well. The method is also compatible with other organs (e.g., lymph nodes, tumors, synovial fluid, fat tissue, etc.) as long as tissue-specific digestion protocols are used.

<table>
	<tbody>
		<tr>
			<td>2-propanol</td>
			<td>Sigma</td>
			<td>I9516-500ML</td>
			<td></td>
		</tr>
		<tr>
			<td>1.7 mL micro-centrifuge tubes</td>
			<td>Axygen</td>
			<td>8187631104051</td>
			<td></td>
		</tr>
		<tr>
			<td>15 mL centrifuge tubes</td>
			<td>Greiner</td>
			<td>188261</td>
			<td></td>
		</tr>
		<tr>
			<td>Absolute ethanol</td>
			<td>Merck</td>
			<td>1.08543.0250</td>
			<td></td>
		</tr>
		<tr>
			<td>Amplitaq Gold</td>
			<td>Thermo Fisher</td>
			<td>N8080241</td>
			<td></td>
		</tr>
		<tr>
			<td>AMPure XP Beads</td>
			<td>Beckman Coulter</td>
			<td>A63881</td>
			<td></td>
		</tr>
		<tr>
			<td>Heat block</td>
			<td>Bioer</td>
			<td>Not applicable</td>
			<td></td>
		</tr>
		<tr>
			<td>High Sensitivity D1000 Sample Buffer</td>
			<td>Agilent</td>
			<td>5067-5603</td>
			<td>For Tapestation</td>
		</tr>
		<tr>
			<td>High Sensitivity D1000 ScreenTape</td>
			<td>Agilent</td>
			<td>5067-5584</td>
			<td>For Tapestation. Tubes sold seperately</td>
		</tr>
		<tr>
			<td>Lymphotrack Assay kit</td>
			<td>Invivoscribe</td>
			<td>TRB: 70-91210039 IGH: 70-92250019</td>
			<td>Each includes 24 indexes</td>
		</tr>
		<tr>
			<td>MiSeq Reagent Kit v2 (500 cycle)</td>
			<td>Illumina</td>
			<td>MS-102-2003</td>
			<td>Includes standard flow cell type and all reagents required</td>
		</tr>
		<tr>
			<td>MiSeq Sequencer</td>
			<td>Illumina</td>
			<td>SY-410-1003</td>
			<td></td>
		</tr>
		<tr>
			<td>PCR strips</td>
			<td>4titude</td>
			<td>4ti-0792</td>
			<td></td>
		</tr>
		<tr>
			<td>Proteinase K</td>
			<td>Invitrogen</td>
			<td>EO0491</td>
			<td></td>
		</tr>
		<tr>
			<td>Qubit 4 Fluorometer</td>
			<td>Thermo Fisher</td>
			<td>Q33226</td>
			<td></td>
		</tr>
		<tr>
			<td>Qubit dsDNA HS Assay Kit</td>
			<td>Thermo Fisher</td>
			<td>Q32854</td>
			<td>Includes buffer, dye, standards, and specialized tubes</td>
		</tr>
		<tr>
			<td>Shaker</td>
			<td>Biosan</td>
			<td>Not applicable</td>
			<td></td>
		</tr>
		<tr>
			<td>Tapestation 2100 Bioanalyzer</td>
			<td>Agilent</td>
			<td>G2940CA</td>
			<td></td>
		</tr>
		<tr>
			<td>ultra pure water</td>
			<td>Bio-lab</td>
			<td>7501</td>
			<td></td>
		</tr>
		<tr>
			<td>Wizard DNA isolation kit</td>
			<td>Promega</td>
			<td>A1120</td>
			<td>Includes cell lysis solution, nuclei lysis solution, and protein precipitation buffer</td>
		</tr>
	</tbody>
</table>

t and b cell receptor immune repertoire analysis using next-generation sequencing

Immunological memory, the hallmark of adaptive immunity, is orchestrated by T and B lymphocytes. In circulation and different organs, there are billions of unique T and B cell clones, and each one can bind a specific antigen, leading to proliferation, differentiation and/or cytokine secretion. The vast heterogeneity in T and B cells is generated by random recombination of different genetic segments. Next-generation sequencing (NGS) technologies, developed in the last decade, enable an unprecedented in-depth view of the T and B cell receptor immune repertoire. Studies in various inflammatory conditions, immunodeficiencies, infections and malignancies demonstrated marked changes in clonality, gene usage, and biophysical properties of immune repertoire, providing important insights about the role of adaptive immune responses in different disorders.
Here, we provide a detailed protocol for NGS of immune repertoire of T and B cells from blood and tissue. We present a pipeline starting from DNA isolation through library preparation, sequencing on NGS sequencer and ending with basic analyses. This method enables exploration of specific T and B cells at the nucleotide or amino-acid level, and thus can identify dynamic changes in lymphocyte populations and diversity parameters in different diseases. This technique is slowly entering clinical practice and has the potential for identification of novel biomarkers, risk stratification and precision medicine.

Herein, we describe a method for DNA isolation from intestinal tissue and blood, preparation of libraries for NGS, and basic steps of a sequencing run for immune repertoire sequencing. The run will generate fastq files, which can be further converted to fasta files for use in the international ImMunoGeneTics (IMGT)/HighV-QUEST platform. This HTS performs and manages many analyses of tens of thousands of rearranged TCR&#946; and IGH sequences, at the nucleotide level15. IMGT/HighV-QUEST enables ana...

Watch this Scientific Journal Video about T and B Cell Receptor Immune Repertoire Analysis using Next-generation Sequencing at JoVE.com

T and B Cell Receptor Immune Repertoire Analysis using Next-generation Sequencing

The current protocol describes a method for DNA isolation from blood samples and intestinal biopsies, generation of TCR&#946; and IGH PCR libraries for next-generation sequencing, performance of a NGS run and basic data analysis.

Immunological memory, the hallmark of adaptive immunity, is orchestrated by T and B lymphocytes. In circulation and different organs, there are billions ...

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8.0K Views.  Sheba Medical Center. The current protocol describes a method for DNA isolation from blood samples and intestinal biopsies, generation of TCRβ and IGH PCR libraries for next-generation sequencing, performance of a NGS run and basic data analysis.