CVID patients with autoimmunity have elevated T cell expression of granzyme B and HLA-DR and reduced levels of Treg cells.

AIMS: Common variable immunodeficiency (CVID) is a primary antibody immunodeficiency with approximately 20% of patients reporting additional autoimmune symptoms. The primary aim of this study was to compare the levels of activated and regulatory T cells (Treg cells) in CVID patients in an attempt to clarify their possible interactions leading to the generation of autoimmunity. METHODS: Immunophenotyping of T cells was performed by flow cytometry using a whole blood approach. Surface expression of human leukocyte antigen HLA class II DR and intracellular levels of granzyme B in T cell subsets were assessed; Treg levels were measured using CD4 CD25, FOXp3 and CTLA-4. RESULTS: CVID patients had higher levels of granzyme B and HLA-DR on CD8(+) T cells compared with control values (mean of 59% vs 30% and 45% vs 21%, respectively). Patients also had reduced levels of Treg cells compared with control values (con mean=3.24% vs pat=2.54%). Patients with autoimmunity (5/23) had a similar level of T cell activation markers to the rest of the patients but with lower Treg cells (mean of 1.1%) and reduced CD25 and CTLA-4 expression. Patients with autoimmunity had a higher ratio of activated to Treg cells compared with patients with no autoimmune symptoms. CONCLUSIONS: These results highlight that reduced levels of Treg cells were associated with elevated levels of activated T cells, suggesting that reduced Treg cells in these patients may have functional consequences in allowing exaggerated T cell responses.

Perioperative reductions in circulating lymphocyte levels predict wound complications after excisional breast cancer surgery.

OBJECTIVE: Postoperative wound complications after excisional surgery for primary breast cancer can result in patients requiring additional treatments and delay adjuvant therapy and are associated with worse prognoses.We investigated factors that might predispose patients to wound complications. BACKGROUND: A number of patient characteristics have been associated with wound complications, but there is currently no quantitative measure of the risk of their occurrence. Our hypothesis was that wound complications are related, in part, to the immune status of patients. METHODS: We recruited patients undergoing surgery for primary breast cancer and determined their circulating levels of various immune cells shortly before and after surgery as a measure of immune status. RESULTS: One hundred seventeen patients were recruited; 16 (13.7%) developed wound complications. The following patient and tumor characteristics were associated with higher wound complication rates: diabetes (P = 0.02); larger tumors (T2/3 vs T1; P = 0.02); metastatic axillary nodes (P = 0.006). With respect to immune status, no significant differences in preoperative levels of circulating immune cells were detected between patients who developed wound complications and those who did not. However, patients who developed complications showed greater reductions in lymphocyte levels 4 hours postoperatively than those who did not (P <0.001). Multivariate analyses demonstrated that falls in lymphocyte levels of greater than 20% or 50% 4 hours postoperatively acted as a significant and independent predictor of wound complications (P < 0.005 and P < 0.0001,respectively). CONCLUSIONS: Perioperative changes in lymphocyte levels could provide a practical predictive marker for wound complications on which selective antibiotic prophylaxis could be based.

Frequency of Treg cells is reduced in CVID patients with autoimmunity and splenomegaly and is associated with expanded CD21lo B lymphocytes.

INTRODUCTION: Common variable immunodeficiency is a heterogeneous antibody deficiency syndrome with autoimmune and inflammatory complications in a significant proportion of patients. The study was designed to evaluate the role of T regulatory (Treg) cells in common variable immunodeficiency (CVID) patients with autoimmunity. METHODS: The number and frequency of Treg cells (CD4(+), CD25(hi), Foxp3(+)) were evaluated in patients and controls, and Foxp3 expression in different subgroups of CVID patients with common clinical manifestations was compared. RESULTS: CVID patients had significantly fewer Treg cells than controls, and low frequency of Treg cells was associated with expansion of CD21(lo) B cells in patients. Patients with autoimmunity had significantly reduced frequency but normal numbers of regulatory T cells, whilst patients with splenomegaly had significant reduction in frequency and number of regulatory T cells. CONCLUSION: Foxp3 is useful on its own or as an adjunct to classify CVID patients although the possibility of reduction in Treg cells as a secondary phenomenon cannot be excluded.

Inherited defects in the interferon-gamma receptor or interleukin-12 signalling pathways are not sufficient to cause allergic disease in children.

T-helper (Th)2 cells, which produce the cytokines interleukins (IL)-4, IL-5 and IL-13, dominate T cell responses in allergic diseases. The Th1-type cytokines IL-12 and interferon-gamma (IFNgamma) are important in down-regulating Th2 responses to allergens. Patients with defects in the IL-12 receptor (IL-12R) or IFNgamma receptor (IFNgammaR) have abnormal responses to IL-12 or IFNgamma and a failure to produce normal levels of IFNgamma. Current paradigms of T-helper subset balance would predict a high prevalence of atopic illness in this group. We have studied a cohort of patients (n =29) with defects in these pathways to assess the prevalence of allergic disease. A questionnaire based on those developed for the International Study of Asthma and Allergy in Childhood (ISAAC) was used in conjunction with analysis of total and specific IgE to common aeroallergens. The prevalence of asthma, eczema and rhino-conjunctivitis (13.7%, 17.5% and 6.8% respectively) in this group was no higher than in comparable populations where prevalences of 13.9%, 7.9% and 13.5% are reported for asthma, eczema and rhinoconjunctivitis respectively. Patients with IFNgammaR defects had higher rates of clinical atopic illness than control populations and patients with IL-12R defects, with 28.5% prevalences for asthma and eczema, respectively. None of the patients suffered from severe clinical atopic disease. Defects in interferon-gamma receptor/interleukin-12 receptor responses are not sufficient to cause clinical allergic disease. Patients with defects in the interferon-gamma receptor pathway have a higher prevalence of high IgE and clinical atopic illness compared to control populations, supporting the concept that interferon-gamma receptor signalling plays a role in down-regulating type-2 cytokine responses.