Clinical aspects and immune reactions in sarcoidosis

Shared αβ TCR Usage in Lungs of Sarcoidosis Patients with Löfgren's Syndrome

Sarcoidosis is a granulomatous disease that primarily affects the lungs and is characterized by an accumulation of CD4⁺ T cells in the bronchoalveolar lavage (BAL). Previous work has indicated that HLA-DRB1*03:01⁺ (DR3⁺) patients diagnosed with the acute form of the disease, Löfgren's syndrome (LS), have an accumulation of CD4⁺ T cells bearing TCRs using TRAV12-1 (formerly AV2S3). However, the importance of these α-chains in disease pathogenesis and the paired TCRβ-chain remains unknown. This study aimed to identify expanded αβTCR pairs expressed on CD4⁺ T cells derived from the BAL of DR3⁺ LS patients. Using a deep-sequencing approach, we determined TCRα- and TCRβ-chain usage, as well as αβTCR pairs expressed on BAL CD4⁺ T cells from LS patients. TRAV12-1 and TRBV2 (formerly BV22) were the most expanded V region gene segments in DR3⁺ LS patients relative to control subjects, and TRAV12-1 and TRBV2 CDR3 motifs were shared among multiple DR3⁺ LS patients. When assessing αβTCR pairing, TRAV12-1 preferentially paired with TRBV2, and these TRAV12-1/TRBV2 TCRs displayed CDR3 homology. These findings suggest that public CD4⁺ TCR repertoires exist among LS patients and that these T cells are recognizing the putative sarcoidosis-associated Ag(s) in the context of DR3.

T cell receptor-Vβ repertoires in lung and blood CD4+ and CD8+ T cells of pulmonary sarcoidosis patients

Background

Sarcoidosis patients have accumulations of activated CD4⁺ T cells in affected organs, such as the lungs. T cell receptor (TCR) Vβ-chain usage has been incompletely characterized in these patients.

Methods

We surveyed the TCR Vβ usage in CD4⁺ and CD8⁺ T cells in bronchoalveolar lavage (BAL) cells and peripheral blood mononuclear cells (PBMC) from 15 HLA-typed Scandinavian sarcoidosis patients. In addition, PBMC from 9 healthy volunteers and BAL cells from three of them were examined. Using 21 Vβ family-specific antibodies, we covered approximately 70% of all Vβ chains.

Results

In BAL T cells from sarcoidosis patients, we identified 16 CD4⁺ T cell expansions in 271 analyses (5.9%) and 21 CD8⁺ expansions in 240 analyses (8.7%). In PBMC we found 9 CD4⁺ expansions in 276 analyses (3.3%) and 12 CD8⁺ expansions out of 263 analyses (4.6%). Consistent with previous studies we found Vβ8 and Vβ16 expansions in sarcoidosis patients’ lungs. In addition, we found lung restricted Vβ22 expansions in three HLA DRB1 03⁺ patients. However, we found no statistically significant difference in frequency of expansions between patients and healthy controls.

Conclusions

The identified T cell expansions in present study indicate specific antigen recognition in the lungs of sarcoidosis patients.

HLA associations and Löfgren's syndrome

Patients with sarcoidosis can be subgrouped according to organ engagement and clinical manifestations. One such subgroup is Löfgren's syndrome (LS), constituting a distinct group of sarcoidosis patients with typical clinical manifestations, separate genetic associations and an immune response that seems to differ from that of non-LS patients. In particular, LS patients have strong associations with HLA-DRB1 alleles, and the well-known association with HLA-DRB1*03 is particularly striking. This particular HLA-DRB1 allele is also a very strong marker within that particular group of patients for a prognostically favorable disease course. This article will mainly discuss genetic associations with LS, and the possible implications of such associations.