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Tibúrcio R, Narendran G, Barreto-Duarte B, Queiroz ATL, Araújo-Pereira M, Anbalagan S, Nayak K, Ravichandran N, Subramani R, Antonelli LRV, Satagopan K, Anbalagan K, Porter BO, Sher A, Swaminathan S, Sereti I, Andrade BB. Frequency of CXCR3+ CD8+ T-Lymphocyte Subsets in Peripheral Blood Is Associated With the Risk of Paradoxical Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome Development in Advanced HIV Disease. Front Immunol 2022; 13:873985. [PMID: 35432354 PMCID: PMC9011055 DOI: 10.3389/fimmu.2022.873985] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is a clinical aggravation of TB symptoms observed among a fraction of HIV coinfected patients shortly after the start of antiretroviral therapy (ART). Of note, TB-IRIS is characterized by exacerbated inflammation and tissue damage that occurs in response to the elevated production of CD4+ T cell-derived IFN-γ. Nevertheless, the possible participation of CD8+ T cells in TB-IRIS development remains unclear.MethodsWe performed a comprehensive assessment of the composition of CD8+ T cell memory subsets and their association with circulating inflammation-related molecules in TB-HIV coinfected patients initiating ART.ResultsWe found that TB-IRIS individuals display higher frequencies of Antigen-experienced CD8+ T cells during the onset of IRIS and that the levels of these cells positively correlate with baseline mycobacterial smear grade. TB-IRIS individuals exhibited higher frequencies of effector memory and lower percentages of naïve CD8+ T cells than their Non-IRIS counterparts. In both TB-IRIS and Non-IRIS patients, ART commencement was associated with fewer significant correlations among memory CD8+ T cells and cells from other immune compartments. Networks analysis revealed distinct patterns of correlation between each memory subset with inflammatory cytokines suggesting different dynamics of CD8+ T cell memory subsets reconstitution. TB-IRIS patients displayed lower levels of memory cells positive for CXCR3 (a chemokine receptor that plays a role in trafficking activated CD8+ T cells to the tissues) than Non-IRIS individuals before and after ART. Furthermore, we found that CXCR3+ naïve CD8+ T cells were inversely associated with the risk of TB-IRIS development. On the other hand, we noticed that the frequencies of CXCR3+ effector CD8+ T cells were positively associated with the probability of TB-IRIS development.ConclusionOur data suggest that TB-IRIS individuals display a distinct profile of memory CD8+ T cell subsets reconstitution after ART initiation. Moreover, our data point to a differential association between the frequencies of CXCR3+ CD8+ T cells and the risk of TB-IRIS development. Collectively, our findings lend insights into the potential role of memory CD8+ T cells in TB-IRIS pathophysiology.
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Affiliation(s)
- Rafael Tibúrcio
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Gopalan Narendran
- Department of Clinical Research, National Institute for Research in Tuberculosis, Chennai, India
| | - Beatriz Barreto-Duarte
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
- Curso de Medicina, Universidade Salvador (UNIFACS), Salvador, Brazil
- Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Artur T. L. Queiroz
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Mariana Araújo-Pereira
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Selvaraj Anbalagan
- Department of Clinical Research, National Institute for Research in Tuberculosis, Chennai, India
| | - Kaustuv Nayak
- Department of Clinical Research, National Institute for Research in Tuberculosis, Chennai, India
- ICGEB-Emory Vaccine Centre, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | | | - Rajasekaran Subramani
- Department of Clinical Research, National Institute for Research in Tuberculosis, Chennai, India
| | - Lis R. V. Antonelli
- Laboratório de Biologia e Imunologia de Doenças Infecciosas e Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
| | | | | | - Brian O. Porter
- HIV Pathogenesis Section, Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Alan Sher
- Immunobiology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Soumya Swaminathan
- Department of Clinical Research, National Institute for Research in Tuberculosis, Chennai, India
| | - Irini Sereti
- HIV Pathogenesis Section, Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Bruno B. Andrade
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
- Curso de Medicina, Universidade Salvador (UNIFACS), Salvador, Brazil
- Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Wellcome Trust Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Curso de Medicina, Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States
- *Correspondence: Bruno B. Andrade,
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6
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Mehta D, Miller C, Arnold DL, Bame E, Bar-Or A, Gold R, Hanna J, Kappos L, Liu S, Matta A, Phillips JT, Robertson D, von Hehn CA, Campbell J, Spach K, Yang L, Fox RJ. Effect of dimethyl fumarate on lymphocytes in RRMS: Implications for clinical practice. Neurology 2019; 92:e1724-e1738. [PMID: 30918100 PMCID: PMC6511089 DOI: 10.1212/wnl.0000000000007262] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/04/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess functional changes in lymphocyte repertoire and subsequent clinical implications during delayed-release dimethyl fumarate (DMF) treatment in patients with multiple sclerosis. METHODS Using peripheral blood from several clinical trials of DMF, immune cell subsets were quantified using flow cytometry. For some patients, lymphocyte counts were assessed after DMF discontinuation. Incidence of adverse events, including serious and opportunistic infections, was assessed. RESULTS In DMF-treated patients, absolute lymphocyte counts (ALCs) demonstrated a pattern of decline followed by stabilization, which also was reflected in the global reduction in numbers of circulating functional lymphocyte subsets. The relative frequencies of circulating memory T- and B-cell populations declined and naive cells increased. No increased incidence of serious infection or malignancy was observed for patients treated with DMF, even when stratified by ALC or T-cell subset frequencies. For patients who discontinued DMF due to lymphopenia, ALCs increased after DMF discontinuation; recovery time varied by ALC level at discontinuation. T-cell subsets closely correlated with ALCs in both longitudinal and cross-sectional analyses. CONCLUSIONS DMF shifted the immunophenotype of circulating lymphocyte subsets. ALCs were closely correlated with CD4+ and CD8+ T-cell counts, indicating that lymphocyte subset monitoring is not required for safety vigilance. No increased risk of serious infection was observed in patients with low T-cell subset counts. Monitoring ALC remains the most effective way of identifying patients at risk of subsequently developing prolonged moderate to severe lymphopenia, a risk factor for progressive multifocal leukoencephalopathy in DMF-treated patients. TRIAL REGISTRATION NUMBERS EUDRA CT 2015-001973-42, NCT00168701, NCT00420212, NCT00451451, and NCT00835770.
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Affiliation(s)
- Devangi Mehta
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT.
| | - Catherine Miller
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT.
| | - Douglas L Arnold
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
| | - Eris Bame
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
| | - Amit Bar-Or
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
| | - Ralf Gold
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
| | - Jerome Hanna
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
| | - Ludwig Kappos
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
| | - Shifang Liu
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
| | - André Matta
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
| | - J Theodore Phillips
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
| | - Derrick Robertson
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
| | - Christian A von Hehn
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
| | - Jordana Campbell
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
| | - Karen Spach
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
| | - Lili Yang
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
| | - Robert J Fox
- From Biogen (D.M., C.M., E.B., J.H., S.L., A.M., C.A.v.H., L.Y.), Cambridge, MA; NeuroRx Research (D.L.A.), Montreal; Montreal Neurological Institute (D.L.A.), McGill University, Montreal, Canada; Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef Hospital, Ruhr University, Bochum, Germany; Department of Neurology (L.K.), University Hospital Basel, Switzerland; University of New Mexico Health Sciences Center (J.T.P.), Albuquerque; Department of Neurology, Multiple Sclerosis Division (D.R.), Morsani College of Medicine, University of South Florida, Tampa; Mellen Center for Multiple Sclerosis, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Envision Pharma Group (J.C.), Sydney, Australia; and Envision Pharma Group (K.S.), Southport, CT
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7
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Silveira-Mattos PS, Narendran G, Akrami K, Fukutani KF, Anbalagan S, Nayak K, Subramanyam S, Subramani R, Vinhaes CL, Souza DOD, Antonelli LR, Satagopan K, Porter BO, Sher A, Swaminathan S, Sereti I, Andrade BB. Differential expression of CXCR3 and CCR6 on CD4 + T-lymphocytes with distinct memory phenotypes characterizes tuberculosis-associated immune reconstitution inflammatory syndrome. Sci Rep 2019; 9:1502. [PMID: 30728405 PMCID: PMC6365576 DOI: 10.1038/s41598-018-37846-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 12/12/2018] [Indexed: 11/09/2022] Open
Abstract
Immune reconstitution inflammatory syndrome (IRIS) occurs in up to 40% of individuals co-infected with pulmonary tuberculosis (PTB) and HIV, primarily upon antiretroviral therapy (ART) initiation. Phenotypic changes in T-cells during TB-IRIS and their relationship with systemic inflammation are not fully understood. In this prospective cohort study, we followed 48 HIV-positive patients with PTB from South India before and after ART initiation, examining T-lymphocyte subsets and inflammatory biomarkers in peripheral blood. Quantification of naïve (CD27+CD45RO-) as well as effector memory CD4+ T cells (CD27-CD45RO+) at weeks 2-6 after ART initiation could distinguish TB-IRIS from non-IRIS individuals. Additional analyses revealed that ART reconstituted different quantities of CD4+ T lymphocyte subsets with preferential expansion of CXCR3+ CCR6- cells in TB-IRIS patients. Moreover, there was an expansion and functional restoration of central memory (CD27+CD45RO+) CXCR3+CCR6- CD4+ lymphocytes and corresponding cytokines, with reduction in CXCR3-CCR6+ cells after ART initiation only in those who developed TB-IRIS. Together, these observations trace a detailed picture of CD4+ T cell subsets tightly associated with IRIS, which may serve as targets for prophylactic and/or therapeutic interventions in the future.
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Affiliation(s)
- Paulo S Silveira-Mattos
- Instituto Gonçalo Moniz, Salvador, Bahia, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Fundação José Silveira, Salvador, Bahia, Brazil
| | | | - Kevan Akrami
- Instituto Gonçalo Moniz, Salvador, Bahia, Brazil.,Division of Infectious Diseases, Department of Medicine, University of California, San Diego, United States of America
| | - Kiyoshi F Fukutani
- Instituto Gonçalo Moniz, Salvador, Bahia, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Fundação José Silveira, Salvador, Bahia, Brazil
| | | | - Kaustuv Nayak
- National Institute for Research in Tuberculosis, Chennai, India
| | | | | | - Caian L Vinhaes
- Instituto Gonçalo Moniz, Salvador, Bahia, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Fundação José Silveira, Salvador, Bahia, Brazil
| | - Deivide Oliveira-de Souza
- Instituto Gonçalo Moniz, Salvador, Bahia, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Fundação José Silveira, Salvador, Bahia, Brazil
| | - Lis R Antonelli
- Laboratório de Biologia e Imunologia de Doenças Infecciosas e Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Kumar Satagopan
- Government Hospital of Thoracic Medicine, Tambaram, Chennai, India
| | - Brian O Porter
- Clinical HIV Pathogenesis Section, Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Alan Sher
- Immunobiology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | | | - Irini Sereti
- Clinical HIV Pathogenesis Section, Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Bruno B Andrade
- Instituto Gonçalo Moniz, Salvador, Bahia, Brazil. .,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Fundação José Silveira, Salvador, Bahia, Brazil. .,Wellcome Trust Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, Republic of South Africa. .,Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil. .,Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil. .,Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
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