Adoptive transfer of CD4+CD25+ regulatory T cells for prevention and treatment of spontaneous abortion

Objectives

The purpose of this study was to examine whether adoptive transfer with in vitro expanded CD4⁺CD25⁺ regulatory T cells (Tregs) could prevent immune response-mediated spontaneous abortion in mice.

Study design

Female CBA/J mice were mated with male Balb/c as the control with normal pregnancy or with DBA/2J mice as a model of spontaneous abortion. The CBA/J mice mated with DBA/2J were treated intravenously with freshly isolated or in vitro expanded Tregs on day 1 or 4 of pregnancy, respectively. The numbers of surviving and reabsorbed fetuses in the different groups of mice were counted on day 14 of pregnancy, and the concentrations of cytokines in individual sera and the supernatants of cultured Tregs were measured by ELISA.

Results

Adoptive transfer with freshly isolated Tregs only slightly reduced the fetal resorption rate, which was not significantly different from that of the mice without Treg treatment, regardless of treatment at early stage and implementation of pregnancy. In contrast, adoptive transfer with in vitro expanded Tregs significantly reduced the fetal resorption rates, particularly for treatment at early stage of pregnancy (P < 0.05). Furthermore, adoptive transfer with in vitro expanded Tregs at early stage of pregnancy significantly increased the levels of serum IL-10, TGF-β1, and the ratios of IL-10 to IFN-γ.

Conclusions

Our data clearly indicated that adoptive transfer with in vitro expanded Tregs at early stage of pregnancy protected fetuses from spontaneous abortion by re-establishing immune tolerance in mice.     

CD4(+)CD25+ T regulatory cells in murine pregnancy

Mammalian pregnancy is thought to be a state of immunological tolerance and immunological pregnancy complications may result from incomplete allo-tolerance. We reported recently a higher frequency of Th1 cytokine-producing T cells specific against paternal antigens in abortion-prone mice compared to normal pregnant mice. Since Th2 cells were shown to be not essential for normal pregnancy; alloreactive Th1 cells must be differently regulated. In this context, T regulatory cells (Treg) were proposed to play an essential role. Normal pregnant mice show an expansion of CD4(+)CD25+ and IL-10+ Treg cells at the periphery compared to non-pregnant animals. Further, we reported significantly lower frequencies of Treg in abortion-prone mice. Interestingly, CD4(+)CD25+ Treg cells from normal pregnant mice were able to prevent fetal rejection. Accordingly, down-regulated levels of Treg were also reported during human miscarriage. The putative mechanisms involved in Treg-induced tolerance in mice and humans are discussed in this review.     

原因不明复发性流产患者外周血及蜕膜组织中CD+4CD+25调节性T细胞比例的变化

目的 探讨原因不明复发性流产(URSA)患者外周血及蜕膜组织中CD+4CD+25调节性T(Tr)细胞比例的变化.方法 采用双荧光标记流式细胞分析技术检测25例URSA患者(流产组)、34例正常早孕妇女(正常妊娠组)和22例正常非孕妇女(正常非孕组)外周血及蜕膜组织中CD+4CD+25Tr细胞的比例.结果 (1)流产组和正常妊娠组妇女外周血CD+4 CDbright25T细胞的比例[分别为(1.55±0.77)%、(2.65±1.10)%]均显著高于正常非孕组妇女[(0.39±0.14)%],分别比较,差异均有统计学意义(P<0.05);流产组妇女外周血CD+4 CDbright25T细胞的比例显著低于正常妊娠组妇女,两组比较,差异有统计学意义(P<0.05).(2)流产组妇女蜕膜组织中CD+4 CDbright25T细胞比例[(0.59±0.23)%]显著低于正常妊娠组妇女[(1.24±0.55)%],两组比较,差异有统计学意义(P<0.01).流产组妇女蜕膜组织中CD+4CDdim25T细胞比例[(4.23±1.52)%]与正常妊娠组[(3.75±1.88)%]比较,差异无统计学意义(P>0.05).(3)正常妊娠组妇女蜕膜组织中CD+4CDbright25T细胞占CD+4T细胞的比例(CD+4CDbright25/CD+4)为(13.10±10.25)%,显著高于外周血[(5.59±2.62)%],两者比较,差异有统计学意义(P<0.05);流产组患者蜕膜组织中CD+4CDbright25/CD+4比例[(5.16±2.83)%]与外周血[(4.64±2.07)%]比较,差异无统计学意义(P>0.05).结论 CD+4CD+25Tr细胞数量在早孕期显著升高,参与了正常妊娠的维持,有可能是调控母-胎界面局部免疫耐受形成的一个重要因素;CD+4 CD+25Tr细胞数量的减少可能与URSA的发生有关.     

原因不明复发性流产主动免疫治疗前后CD4+ CD25+调节性T细胞表达频率的研究

目的探讨CD4^＋CD25^＋调节性T细胞（Tr）在原因不明复发性流产（URSA）患者主动免疫治疗中的作用。方法上海交通大学医学院附属仁济医院对2004-03—2005-05就诊于门诊的18例URSA患者，采用双荧光标记流式细胞分析技术，检测其淋巴细胞主动免疫治疗前后外周血CD4^＋CD25^＋Tr细胞表达频率的变化。结果主动免疫治疗后URSA组外周血中CD4^＋CD25^＋种Tr较治疗前明显增加（P〈0．05），CD4^＋CD25^＋较治疗前降低（P〈0．05）。主动免疫治疗后，妊娠成功的妇女CD4^＋CD25^brightTr显著多于妊娠失败者。结论主动免疫治疗可提高外周血CD4^＋CD25^brightTr数量，CD4^＋CD25^brightTr可能是调控母胎界面局部免疫耐受形成的一个重要因素，有可能成为URSA患者主动免疫治疗的监测指标之一。     

Coding region polymorphisms in the indoleamine 2,3-dioxygenase (INDO) gene and recurrent spontaneous abortion

Indoleamine 2,3-dioxygenase (INDO) catalyzes degradation of the indole ring of indoleamines and locally depletes tryptophan. INDO expression suppresses T cell proliferation and activation. Genetic variation in the INDO gene may contribute to the variable INDO enzyme expression, activity and severity of some diseases. Recurrent spontaneous abortion (RSA) is a common pregnancy complication and the exact causes of RSA are not yet known. We performed an association study between INDO single nucleotide polymorphisms (SNPs) and RSA. To identify INDO SNPs we sequenced DNA samples for ten exons and adjacent intronic regions from 111 RSA patients. Consequently 10 SNPs were detected; four in exons (one in exon 4, two in exon 9 and one in exon 10) and six in intronic regions (one in intron 3, three in intron 6, one in intron 8 and one in intron 9). Three (IVS3+562 del C, IVS8+116 T→G and IVS9+2431 G→A) of these ten SNPs have been registered at the NCBI SNP database. Statistical analysis of allele, genotype and haplotype frequency distribution in the three most frequent SNPs (IVS3+562 del C, IVS6+61 G→A and IVS9+2431 G→A) showed no significant differences between the 111 RSA and 105 matched control women. CGA and CGG were the most frequent haplotypes in both the RSA and control groups. We conclude that there is no association between INDO polymorphisms and susceptibility of Iranian women to RSA.     

CD4(+)CD25high regulatory T cells in human pregnancy

In both rodent and human systems, there is an emerging consensus that immunoregulatory activity specific for donor alloantigens is enriched in the CD4(+)CD25+ T cell population. The absence of CD4(+)CD25+ regulatory T (Treg) cells induces severe immunodeficiency with autoimmune disease, dermatitis and fatal infections in humans and mice. CD4(+)CD25+ Treg cells play a critical role in peripheral tolerance, transplantation tolerance and maternal tolerance to the fetus. Although both human and mouse CD4(+)CD25+ Treg have potent regulatory properties, surface phenotypes of human CD4(+)CD25+ Treg cells are not exactly the same as those of mouse CD4(+)CD25+ Treg cells. Murine CD4(+)CD25+ T cells are homogenous and exhibit regulatory function. On the other hand, CD4(+)CD25high T cells are the only cells which exhibit regulatory function in humans. Humans CD4(+)CD25low cells have no ability for immunosuppression. CD4(+)CD25high T cells inhibit the immunostimulation of conventional T cells through cell-to-cell contact or immunosuppressive cytokines such as interleukin 10 and transforming growth factor-beta. As another mechanism of immunosuppression, CTLA-4 on CD4(+)CD25+ regulatory T cells up-regulate indoleamine 2,3-dioxygenase (IDO) expression in dendritic cells which play important roles for immunosuppression. Here, we review the differences between humans and mouse Treg cells and the role of CD4(+)CD25+Treg during pregnancy.     

Decidual CD4+CD25+CD127dim/- regulatory T cells in patients with unexplained recurrent spontaneous miscarriage

Objectives

To investigate the frequency and function of CD4⁺CD25⁺CD127^dim/− regulatory T (Treg) cells in decidua of patients with unexplained recurrent spontaneous miscarriage (URSM).

Study design

The decidual lymphocytes from patients who experienced URSM and normal pregnant women (controls) were collected by Ficoll density gradient centrifugation. CD4⁺CD25⁺CD127^dim/− Treg cells were isolated by magnetic cell sorting. The proportion of Treg cells and IL-10, TGF-β in Treg cells were determined by flow cytometry. Inhibitory effects of Treg cells on effecter T cells were detected with or without the presentation of anti-IL-10 antibodies and anti-TGF-β antibodies.

Results

The frequency of CD4⁺CD25⁺CD127^dim/− Treg cells was decreased in URSM decidua compared to controls (2.09% ± 0.86% vs. 2.97% ± 1.19%, p = 0.005), and the expression of IL-10 and TGF-β in Treg cells was lower in the URSM group than in the control group (p = 0.04 and p = 0.01, respectively). Furthermore, the suppressive effect of CD4⁺CD25⁺CD127^dim/− Treg cells on the proliferation of effector T cells was decreased in URSM decidua (p < 0.05). Suppression was mediated predominantly through IL-10 and TGF-β in decidua.

Conclusions

Decreased frequency and immunosuppressive capacity of CD4⁺CD25⁺CD127^dim/− Treg cells was found in URSM decidua. Treg cells inhibit proliferation of effector T cells mainly via IL-10 and TGF-β in URSM decidua.     

CD4~+CD25~+FOXP3~+调节性T淋巴细胞数量及功能变化与子宫内膜异位症患者发病相关性研究

目的:分析子宫内膜异位症(EMs)患者在位、异位内膜及外周血内CD4~+CD25~+FOXP3~+调节性T淋巴细胞(Treg细胞)的数量、分布及功能特性,探讨Treg细胞与EMs发病之间的关系。方法:收集EMs患者在位、异位内膜组织及外周血标本,并以非内异症患者作为对照,免疫组化分析在位、异位内膜内叉头状/翅膀状螺旋转录因子3(FOXP3)阳性细胞的数量及分布变化情况,并与EMs患者的r AFS临床分期进行相关性分析。流式细胞术检测Treg细胞占外周血CD4~+T淋巴细胞的百分比,及磁珠分选外周血内CD4~+CD25~+T细胞及CD4~+CD25-T细胞,3H-thymidine法测定CD4~+CD25~+T细胞免疫抑制功能变化情况。结果:EMs、非EMs患者在位内膜内平均FOXP3阳性细胞密度并无显著差异[(76.44±62.14)/mm~2vs(50.59±20.79)/mm~2;WU=152.0,P=0.20]。进一步按月经周期行亚组分析:EMs分泌期内膜内FOXP3阳性细胞密度显著高于非EMs患者[(94.84±53.91)/mm~2vs(31.37±19.02)/mm~2;MU=43.00,P=0.03]。不同r AFS期别患者卵巢异位症病灶内FOXP3阳性细胞密度并无显著差异[I~II期:(123.00±115.00)/mm~2vs III~IV期:(111.00±108.00)/mm~2;MU=139.5,P0.05]。EMs患者外周血内Treg细胞比例显著低于非EMs患者[(0.58±0.21)%vs(1.35±0.38)%,P0.001],但EMs患者外周血CD4~+CD25~+T淋巴细胞对CD4~+CD25-T淋巴细胞增殖抑制率,与非EMs相比并无显著变化[(68.43±18.15)%vs(66.37±17.78)%,P0.05]。结论:EMs患者在位内膜内Treg细胞失去正常的周期波动性,EMs患者分泌期内Treg细胞数目增加可能与内异症发病相关。EMs患者外周血内Treg细胞比例下降,但其免疫抑制功能并无明显改变。     

Localization of indoleamine 2,3-dioxygenase and 4-hydroxynonenal in normal and pre-eclamptic placentae

This study was undertaken to compare placental levels of 2,3-Dioxygenase (IDO), a free radical scavenger, and 4-Hydroxynonenal (4-HNE), a major by-product of lipid peroxidation, in normal and pre-eclamptic pregnancies. Placentae were collected at caesarean section from women with a term, normal singleton pregnancy (37-40 weeks' gestation, n=10) and women with a term singleton pregnancy complicated by pre-eclampsia (n=10). IDO and 4-HNE localization and intensity was studied by semi-quantitative immunohistochemistry and differences between groups were analysed using the Mann-Whitney U test. Immunostaining for IDO was located primarily in endothelial cell nuclei, with a reduced level of staining in the cytoplasm, in most capillaries from all placentae examined. A significantly higher level of IDO immunostaining was observed in normal placentae compared to pre-eclamptic placentae (P=0.008). 4-HNE was located mainly in the cytoplasm of syncytiotrophoblast cells of all placentae examined. There were no significant differences in the pattern or intensity of 4-HNE immunostaining levels between normal and pre-eclamptic pregnancies (P=0.684). Our IDO results support the hypothesis of decreased anti-oxidative capability in the placenta and the possibility of an ineffective compensatory mechanism against increased oxidative stress in the fetus.     

泼尼松治疗原发性肾病综合征对患儿CD4+CD25+调节性T细胞的影响分析

目的　观察原发性肾病综合征（PNS）患儿泼尼松治疗前后CD4+CD25+ 调节性T细胞（CD4+CD25+ Tr）的变化,阐明肾上腺糖皮质激素治疗儿童PNS的免疫机制。方法　选择2004—2007年在深圳市儿童医院住院治疗的初发PNS患儿42例,其中激素敏感型32例,激素耐药型10例。同期25例健康体检儿童作为对照组。流式细胞术检测泼尼松治疗前后外周血CD3+CD4+CD8-、CD3+CD4-CD8+、CD4+CD25+Tr的比例,荧光定量聚合酶链反应（Real-time PCR）检测泼尼松治疗前后外周血单个核细胞（PBMC）叉头型基因P3（Foxp3）、细胞毒性T淋巴细胞相关抗原4（CTLA-4）和糖皮质激素诱导的肿瘤坏死因子受体 （GITR）基因mRNA的表达。结果 　与对照组比较,PNS患儿外周血CD3+CD4+CD8- T细胞、CD3+CD4-CD8+ T细胞、CD4+CD25+ Tr比例无明显改变（P > 0.05）。激素敏感型PNS患儿CD4+CD25+Tr比例在泼尼松治疗后明显增高,差异有统计学意义（P < 0.01）;激素耐药型PNS患儿CD4+CD25+Tr比例在泼尼松治疗前后无明显改变（P > 0.05）。激素敏感型PNS患儿在泼尼松治疗后PBMC细胞Foxp3、CTLA-4和GITR基因mRNA的表达明显增高;而激素耐药型PNS患儿泼尼松治疗前后Foxp3、CTLA-4基因表达无明显改变,仅GITR表达明显增高。 结论 泼尼松等肾上腺糖皮质激素类药物可通过上调激素敏感型PNS患儿CD4+CD25+调节性T细胞的表达发挥免疫治疗作用。     

CD4+CDhigh25调节性T淋巴细胞在妊娠肝内胆汁淤积症发病中的作用

目的 探讨妊娠肝内胆汁淤积症(ICP)患者外周血与蜕膜组织CD4+CD25+凋节性T淋巴细胞(Treg细胞)及CD4+CD25hJigh细胞在ICP发病中的作用.方法 采用流式细胞仪检测30例ICP患者(ICP组,其中轻度15例,重度15例)及28例正常晚期妊娠妇女(对照组)外周血和蜕膜组织CD4+CD25+Treg细胞及CD4+CD25hJigh细胞占CD+T淋巴细胞的百分率,分析其与ICP发病的关系.结果 ICP组外周血CD4+CD25+Treg细胞百分率为(7.96±1.32)%,CD4+CD25high细胞了百分率为(0.78±0.22)%,均低于对照组[(17.05±2.86)%、(1.71±0.69)%],分别比较,差异均有统计学意义(P<0.01);ICP组蜕膜组织CD4+CD25+Treg细胞百分率为(17.18±2.27)%,CD+4CD25highTreg细胞百分率为(2.25±0.89)%,也均低于对照组[(32.01±3.88)%、(8.30±1.13)%],分别比较,差异也均有统计学意义(P<0.01).ICP组及对照组蜕膜组织中CD4+CD25+Treg细胞及CD4+CD25highTreg细胞百分率均高于外周血,差异均有统计学意义(P<0.01).ICP组轻度及重度患者外周血CD4+CD25+Treg细胞百分率分别为(8.74±0.96)%、(7.17±1.17)%,CD4+CD25hiithTreg细胞百分率分别为(0.89 ±0.20)%、(0.68±0.19)%,而蜕膜组织CD4+CD25+Treg细胞百分率分别为(18.43 ±1.90)%、(15.94±1.95)%,CD4+CD25highTreg细胞百分率分别为(2.62±0.72)%、(1.87±0.90)%,ICP组外周血及蜕膜组织CD4+CD25high胞及CD4+CD25+Treg细胞百分率随着病情的加重呈下降趋势,分别比较,差异均有统计学意义(P<0.05).结论 CD4+CD25+Treg细胞及CD4+CD25+highTreg细胞可能参与ICP的发病过程,并与病情的严重程度密切相关.     

Distribution of CD4+CD25highFoxP3+ regulatory T-cells in umbilical cord blood

Objective: This study aimed to establish reference intervals for lymphocyte subsets including CD4⁺CD25^highFoxP3⁺ regulatory T-cells (Tregs) in umbilical cord blood. Methods: Umbilical cord blood was obtained after birth from 120 healthy full-term neonates, who were born between November 2010 and November 2011. Lymphocyte subsets including Tregs were analysed using flow cytometer (Beckman Coulter, Fullerton, CA, USA), and the reference intervals were defined using non-parametrical percentile methods according to the Clinical and Laboratory Standard Institute guideline (C28-A3). Results: The reference intervals for lymphocyte subsets were: helper T-cells (CD3⁺/CD4⁺), 15.40–70.06%; cytotoxic T-cells (CD3⁺/CD8⁺), 9.65–34.28%; B-cells (CD19⁺), 4.50–29.59%; and natural killer cells (CD3^?/CD16⁺/CD56⁺), 1.42–28.03%. The reference interval for Tregs was 0.35–9.07%. Conclusions: This study provides the reference intervals for lymphocyte subsets including Tregs in umbilical cord blood from healthy full-term neonates. These results could be used as fundamental data for clinical laboratory tests as well as future researches.     

Decreased frequency of peripheral blood CD8+CD25+FoxP3+regulatory T cells correlates with IL-33 levels in pre-eclampsia

Objective: We aimed to investigate the role of CD8⁺CD25⁺Foxp3⁺regulatory T (Treg) cells in pre-eclampsia (PE).

Methods: This was a cross-sectional study of 46 patients with PE and 24 normotensive women within the third trimester of gestation. We analyzed the percentages of CD8⁺CD25⁺Foxp3⁺Treg cells in peripheral blood using flow cytometry and the serum levels of interleukin (IL)-6, IL-17A, IL-10, TGF-β1, IL-1β, and IL-33 by Luminex 200.

Results: We found that patients with PE had lower percentages of CD8⁺CD25⁺Foxp3⁺Treg cells than normotensive pregnant women. In addition, the percentage of CD8⁺CD25⁺Foxp3⁺Treg cells was positively correlated with IL-33 concentration and negatively correlated with IL-17A concentration in patients with PE. We also found that IL-33 treatment can induce proliferation of CD8⁺CD25⁺Foxp3⁺Treg cells in vitro.

Conclusions: These findings suggest that the reduced CD8⁺CD25⁺Foxp3⁺Treg cells may play a role in the pathogenesis of PE.

Abbreviations

PE: pre-eclampsia; PBMCs: peripheral blood mononuclear cells; CTLA-4: cytotoxic T-lymphocyteantigen-4; APCs: antigen presenting cells; TGF-β: transforming growth factor-β; IL: interleukin; Treg: cells regulatory T cells; PBS: phosphate-buffered saline; Foxp3: forkhead Box protein 3; HELLPs: hemolysis, elevated liver enzyme and low platelet syndrome     

再生障碍性贫血患儿CD+4CD+25T细胞及TGF β1Flt 3L水平变化的意义

目的评价免疫调节T细胞和细胞因子在再生障碍性贫血(再障)细胞免疫功能紊乱中的作用。 方法2004 02—2005 06中山大学第二附属医院采用流式细胞术检测27例特发性再障患儿骨髓及外周血淋巴细胞亚群和CD+4CD+25T细胞水平，ELISA检测骨髓转化生长因子(TGF β1)和Flt 3L水平，并与正常儿童对照。 结果与对照组比较，初诊再障患儿外周血和骨髓CD+8T细胞均显著增高(P<0.05)，重型再障(SAA)组伴外周血CD-3CD+56NK细胞及骨髓B细胞显著下降(P<0.05)。初诊SAA组骨髓CD+4CD+25T细胞\[(7.5±3.4)%\]显著高于对照组\[(4.3±0.9)%，P<0.05\]，初诊SAA组及轻型再障(MAA)组骨髓CD+4CD+25/CD+4比值分别为(28.9±11.1)%和(28.2±9.4)%，均显著高于对照组\[(17.4±0.9)%，P均<0.05\]，骨髓TGF β1分别为(2.2±1.7)μg/L和(2.0±0.6)μg/L，均较对照组［(4.4±0.9)μg/L］显著降低(分别为P<0.01、P<0.05)，而Flt 3L水平分别为(1031.1±321.8)ng/L和(694.7±424.7)ng/L，均较对照组［(63.0±37.5)ng/L］显著增高(P均<0.01)。缓解期SAA儿童除外周血CD+8T细胞仍较对照组显著增高外，其余上述指标均接近正常水平。相关分析显示，骨髓CD+4CD+25T细胞与CD+3CD+4T细胞呈显著正相关(r分别为0.495、0.540,P<0.01)；Flt 3L与骨髓CD+3、CD+4、CD+8T细胞及CD+4CD+25T细胞均呈显著正相关(r分别为0.732、0.542、0.688、0.405,P分别<0.01、0.01、0.01、0.05)，而TGF β1与骨髓CD+8T细胞和Flt 3L水平呈显著负相关(r分别为-0.431、-0.482,P分别<0.05、<0.01)。 结论儿童再障发病与CD+4CD+25T细胞数量缺乏无关，骨髓TGF β1水平显著降低和Flt 3L水平显著增高可能在再障儿童T淋巴细胞数量增多和功能紊乱中起重要作用。     

原因不明复发性流产与蜕膜CD4~+ CD25~+ T调节细胞和CD8~+ CD28~- T细胞的关系

目的:探讨原因不明复发性流产(unexplained recurrent spontaneous abortion,URSA)与蜕膜CD4+ CD25+ T细胞和CD8+ CD28-T细胞的关系。方法:采用流式细胞四色荧光法,检测原因不明复发性流产17例(URSA组)和正常早孕人流20例(对照组)的蜕膜CD4+ CD25+ T细胞及其FoxP3(+)表达,CD8+ CD28- T细胞及其表面CD95、CD95L表达。结果:两组蜕膜中CD4+ CD25+ T细胞比例无明显差异(P>0.05),URSA组蜕膜CD4+ CD25+ T细胞中FoxP3阳性率明显低于对照组(P<0.0001)。两组蜕膜CD8+ CD28- T细胞比例及其细胞表面CD95和CD95L的阳性表达率均无明显差异(P>0.05);结论:蜕膜CD4+ CD25+ FoxP3(+)T调节细胞明显减少,是导致URSA患者母胎界面免疫耐受异常的重要原因。