Decreased frequencies of CD4+CD25+Foxp3+ cells and the potent CD103+ subset in peripheral lymph nodes correlate with autoimmune disease predisposition in some strains of mice.

The CD4(+)CD25(+)Foxp3(+) cells are essential for regulation of the immune response, and the integrin, CD103 (α(E)ß(7)), identifies a potent subset of these cells. Defects in CD4(+)CD25(+)Foxp3(+) cells are thought to contribute to susceptibility to autoimmune disease in predisposed individuals. Studies evaluating the quality and quantity of CD4(+)CD25(+)Foxp3(+) regulatory cell populations in the context of autoimmune disease susceptibility have been inconclusive, and few if any, have analyzed the CD103 subset. In this study, we analyzed regulatory T cells (Tregs) from different strains of mice with varying degrees of susceptibility to autoimmune disease. We found no differences in the ability of CD4(+)CD25(+) or the CD103(+) subset of Tregs from young female (NZB × NZW)F1 (BWF1), SJL, C57BL/6, or BALB/c mice to suppress CD4(+)CD25(- ) responders in vitro. Analysis of CD4(+)Foxp3(+) and CD4(+)CD25(+)CD103(+) cell frequencies in lymphoid organs revealed that BWF1 mice had dramatically lower percentages of both populations in the lymph node (LN) than the other strains, and lower percentages in the spleen in all but the C57BL/6 strain. We next determined whether these findings extended to another autoimmune-prone strain. Similar to BWF1 mice, percentages of CD4(+)Foxp3(+) and CD4(+)CD25(+)CD103(+) cells were significantly lower in predisease NOD mice. The low frequencies of CD4(+)Foxp3(+) and CD4(+)CD25(+)CD103(+) cells in BWF1 and NOD mice were not due to deficiencies in either thymic production or homeostatic proliferation. These data indicate that decreased percentages of CD4(+)Foxp3(+) cells and particularly, CD4(+)CD25(+)CD103(+) cells in LN correlate with the predisposition to spontaneous development of autoimmune disease.

HE3286, an orally bioavailable synthetic analogue of an active DHEA metabolite suppresses spontaneous autoimmune diabetes in the non-obese diabetic (NOD) mouse.

5-Androstene-3ß,7ß,17ß-triol (AET) is a naturally occurring anti-inflammatory adrenal steroid that limits acute and chronic inflammation. HE3286 (17α-ethynyl-5-androstene-3ß,7ß,17ß-triol) is a synthetic derivative of AET with improved pharmaceutical properties and efficacy in some animal models of autoimmunity. Here, daily oral doses of HE3286 led to a suppression of spontaneous autoimmune diabetes in the non-obese diabetic mouse model of type 1 diabetes mellitus when administered either shortly before or after the first incidence of disease onset. Efficacy was associated with reduced insulitis and a suppression of the pathogenic T helper cell type 1 and type 17 phenotypes in peripheral lymphoid organs. These results demonstrate that daily oral treatment with HE3286 administrated relatively late in the destructive autoimmune process led to a suppression of type 1 diabetes mellitus onset and of the pathological inflammatory status, supporting its clinical evaluation in type 1 diabetes mellitus subjects.

Short-term hyperglycemia in surgical patients and a study of related cellular mechanisms.

OBJECTIVE: To examine cellular mechanisms by which short-term elevations of glucose or insulin impair leukocyte functions and to assess the occurrence of perioperative hyperglycemia in surgical patients. SUMMARY BACKGROUND DATA: A major factor in the contemporary management of the critically ill surgical patient is the progressively exact control of blood glucose. However, the separate role of insulin and underlying immunologic mechanisms are not well understood. METHODS: Venous blood samples of 20 healthy volunteers were exposed for 24 hours to various glucose and insulin concentrations. Lipopolysaccharide (LPS) was added at 1 ng/mL for up to 16 hours and the monocytes' ability to express CD14 and HLA-DR assessed as an index of the monocyte's capability to present antigen. To evaluate the clinical importance of the observed experimental results, a prospective evaluation of perioperative blood glucose values in 5285 surgical patients in Kentucky was performed. RESULTS: Both exposure to high glucose (400 mg/dL) and insulin (100 muU/mL) led to an independent and additive impairment of monocyte HLA-DR expression after 24 hours (P < 0.01). Perioperative blood glucose exceeded 200 mg/dL in 21% of all cardiothoracic patients and in 31% of diabetic patients undergoing common major operations. CONCLUSIONS: Both short-term hyperglycemia and hyperinsulinemia are associated with significantly decreased monocyte HLA-DR expression, a parameter correlating with infectious complications and patient mortality. This may provide a mechanism by which high glucose and insulin impair innate immunity. It also appears that perioperative maintenance of normoglycemia will become a valid performance measure for practicing surgical specialists.