1
|
Singla S, Wenderfer SE, Muscal E, Sagcal-Gironella ACP, Orange JS, Makedonas G. Changes in Frequency and Activation Status of Major CD4 + T-Cell Subsets after Initiation of Immunosuppressive Therapy in a Patient with New Diagnosis Childhood-Onset Systemic Lupus Erythematosus. Front Pediatr 2017; 5:104. [PMID: 28555177 PMCID: PMC5430328 DOI: 10.3389/fped.2017.00104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 04/24/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Several studies suggest that defects of regulatory T-cells (Tregs) and impaired cellular immunity are secondary to an imbalance between auto-aggressive T-cells and Tregs in lupus patients. Discrepancies in Tregs and effector T-cells (Teff) in active lupus patients are shown to be restored in patients upon receiving immunosuppressive therapy. Therefore, our main aim was to observe frequencies of these CD4+ T-cell subsets and Tregs/Teff ratio in a new diagnosis of childhood-onset systemic lupus erythematous (cSLE) before and after initiation of therapy. In addition, we monitored T-cell exhaustion status by examining responses to super-antigen staphylococcal enterotoxin B (SEB) and PD-1 expression in this patient. METHODS Phenotyping of CD4+ T-cell subsets was carried out under basal conditions and after SEB stimulation using flow cytometry in one inactive (I-cSLE) and one active cSLE (A-cSLE) patient, as well as a healthy control (HC). The A-cSLE patient was a new diagnosis. Variables were measured at three consecutive time points in the active patient, reflecting various stages of disease activity. Activation status of CD4+ T-cells in the A-cSLE patient was compared to that of the I-cSLE patient and HC. Disease activity was measured by calculating the systemic lupus erythematous disease activity index. RESULTS We found that the A-cSLE patient was not Tregs deficient. The patient had increased frequency of Tregs, and the Tregs/Teff ratio increased when the disease activity became less severe. CD4+ T-cells in the I-cSLE patient and in the A-cSLE patient with milder disease activity had heightened responsiveness to SEB, whereas T-cells were relatively hypo-responsive to SEB in the A-cSLE patient when disease activity was higher. The active patient exhibited higher frequencies of PD-1+ expressing Tregs, Teff, and Tnaïve/mem cells under basal conditions compared to the HC and I-cSLE patient. CONCLUSION In the A-cSLE patient, changes in Tregs/Teff ratio correlated better with clinical improvement compared to Tregs frequencies alone and might reflect the restoration of immune homeostasis with therapy. SEB hypo-responsiveness in the A-cSLE patient when disease activity was higher paralleled with findings of greater frequencies of PD-1+ expressing Tregs, Teff, and Tnaïve/mem cells, suggests a possible global exhaustion status of CD4+ T-cells in this patient.
Collapse
Affiliation(s)
- Saimun Singla
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Division of Allergy, Immunology and Rheumatology, Texas Children's Hospital, Houston, TX, USA
| | - Scott E Wenderfer
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Renal Section, Texas Children's Hospital, Houston, TX, USA
| | - Eyal Muscal
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Division of Allergy, Immunology and Rheumatology, Texas Children's Hospital, Houston, TX, USA
| | - Anna Carmela P Sagcal-Gironella
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Division of Allergy, Immunology and Rheumatology, Texas Children's Hospital, Houston, TX, USA
| | - Jordan S Orange
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Division of Allergy, Immunology and Rheumatology, Texas Children's Hospital, Houston, TX, USA
| | - George Makedonas
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Division of Allergy, Immunology and Rheumatology, Texas Children's Hospital, Houston, TX, USA
| |
Collapse
|