SummaryImmunoglobulin (Ig) genes were isolated from unamplified conventional as well as polymerase chain reaction-generated cDNA libraries constructed from the peripheral blood cells of a patient with complete DiGeorge syndrome. Comparison of the sequences of 36 heavy chain clones to the recently expanded database of human V. genes permitted identification of the germline V. genes that are expressed in this patient as well as placement of 19 of these genes in a partially resolved 0.8-mb region of the human V. locus. The pattern of V. gene use does not resemble the fetal (early) repertoire. However, as in the fetal repertoire, there are a number of cDNAs derived from germline genes that previously have been identified as autoantibodies. Two D/~ sequences also were identified, as was another sequence resulting from a unique recombination event linking J. to an unidentified sequence containing a recombination signal sequence-like heptamer. All of the DiGeorge cDNAs are closely related to germline V~ genes, showing little or no evidence of somatic mutation. In contrast, comparably selected IgM V. sequences derived from normal adult and age-matched human libraries, and from a second DiGeorge syndrome patient in whom the degree of thymic dysfunction is much less severe, exhibit considerable evidence of somatic mutation. The absence of somatic mutation is consistent with the atypical development of functional antibody responses associated with complete DiGeorge syndrome and implicates a role for T cells in the generation of diversity within the B cell repertoire. nalyses of the Ig repertoire, as represented in peripheral blood, have been the focus of recent investigations. Owing to the relative ease of PCR amplification, most of the efforts have been directed at the CDR3 junction and the generation of diversity through D. element (as well as J.) usage and modification (1-3). Studies of the human fetal and cord blood repertoires have been carried out using conventional cDNA libraries (4-7), and while the normal human V. repertoire has not been studied extensively in terms of expression of specific V. genes, recent advances in the enumeration and mapping of germline V. genes (8-10) now allow such investigations. These findings have had considerable impact in terms of our understanding of the developmental expression of Ig genes as well as the relationship of autoimmunity to specific genes. The nature of Ig gene usage in human primary immunodeficiency diseases, including X-linked agammaglobulinemia (11-13) common variable immunodeficiency (14) and severe combined immunodeficiency (15), has been examined. The present report addresses the Ig gene repertoire of patients with DiGeorge syndrome, a developmental field defect that involves dysmorphogenesis of the third and fourth pharyngeal pouches and is associated with varying degrees of fascial dysmorphia, hypoparathyroidism, anomalies of the great cardiac vessels, and partial development of the thymus. Abnormal B cell function in these patients is associated with the thymic ...