Oestrogen up‐regulates interleukin‐21 production by CD4+ T lymphocytes in patients with systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune disease in which abnormal immune responses are mediated by tissue‐binding autoantibodies and immune complex deposition. Because most SLE patients are women of child‐bearing age, oestrogen has been suggested to play an important role in SLE pathogenesis. One proposed role is to induce B‐cell activation, culminating in increased autoantibody production. Interleukin‐21 (IL‐21) has been shown to be crucial in the differentiation of activated B cells into plasma cells. We therefore hypothesized that oestrogen up‐regulates IL‐21 production and induces subsequent B‐cell activation in SLE patients. Peripheral blood was obtained from 22 SLE patients and 16 healthy controls. Expression levels of IL‐21 and its receptor in serum, peripheral blood mononuclear cells, and CD4⁺ T cells were higher in SLE patients than in healthy controls. Exposure of CD4⁺ T cells from SLE patients to 17β‐oestradiol led to a dose‐ and time‐dependent increase in IL‐21 expression, which was abolished in the presence of mitogen‐activated protein kinase (MAPK) (MAPK kinase, p38, Jun N‐terminal kinase) inhibitors. B cells from healthy controls showed increased antibody production when they were co‐cultured with oestrogen‐treated CD4⁺ T cells from SLE patients. Treatment with IL‐21 antibody abrogated the increased antibody production of the co‐culture systems. This study revealed the association between oestrogen and IL‐21 in SLE patients. Oestrogen up‐regulates IL‐21 expression of CD4⁺ T cells via MAPK‐dependent pathways in SLE patients, which in turn induces increased antibody production by B cells.     

CD134 expression on CD4+ T cells is associated with nephritis and disease activity in patients with systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is characterized by a deviation of the immune system that involves T cell-dependent autoantibody production. The aim of this study was to investigate the role of co-stimulatory markers on T cells in this disease. Twenty-eight patients with SLE as defined by the American College of Rheumatology (ACR) criteria and 11 healthy controls were included into the study. Eleven patients had biopsy-proven lupus nephritis while 17 patients had no clinical evidence of lupus nephritis. Clinical disease activity was assessed according to the systemic lupus erythematosus disease index (SLEDAI). CD4+ T cell populations in the peripheral blood were analysed for the expression of co-stimulatory markers CD45RO, CD70, CD80, CD86, CD137, CD137L, CD134, CD152, CD154 and ICOS. SLE patients showed an increased frequency of peripheral CD4+ T cells expressing high levels of CD80, CD86 and CD134 compared to healthy controls (7.1 +/- 1.5% versus 1.7 +/- 0.9%; P < 0.005; 2.3 +/- 0.4% versus 1.0 +/- 0.2%; P = 0.008, 20.2 +/- 2.0% versus 10.6 +/- 1.9%; P < 0.005, respectively). Significantly higher levels of CD80 on CD4+ T cells were detected in SLE patients with lupus nephritis compared to patients without nephritis (11.9 +/- 3.3% versus 4.0 +/- 0.7%; P < 0.005). There was an increased presence of CD134+ CD4+ cells in SLE patients with lupus nephritis (27.5 +/- 4.0% versus 15.5 +/- 1.3%; P < 0.005). CD80 and CD134 expression was significantly correlated with SLEDAI (r = 0.42, P = 0.03; r = 0.56, P < 0.005). Co-stimulatory molecules on CD4+ T cells are associated with renal disease and disease activity in patients with systemic lupus erythematosus.     

Abnormal CTLA‐4 function in T cells from patients with systemic lupus erythematosus

CTLA‐4 is a critical gatekeeper of T‐cell activation and immunological tolerance and has been implicated in patients with a variety of autoimmune diseases through genetic association. Since T cells from patients with the autoimmune disease systemic lupus erythematosus (SLE) display a characteristic hyperactive phenotype, we investigated the function of CTLA‐4 in SLE. Our results reveal increased CTLA‐4 expression in FOXP3^? responder T cells from patients with SLE compared with other autoimmune rheumatic diseases and healthy controls. However, CTLA‐4 was unable to regulate T‐cell proliferation, lipid microdomain formation and phosphorylation of TCR‐ζ following CD3/CD28 co‐stimulation, in contrast to healthy T cells. Although lupus T cells responded in vitro to CD3/CD28 co‐stimulation, there was no parallel increase in CTLA‐4 expression, which would normally provide a break on T‐cell proliferation. These defects were associated with exclusion of CTLA‐4 from lipid microdomains providing an anatomical basis for its loss of function. Collectively our data identify CTLA‐4 dysfunction as a potential cause for abnormal T‐cell activation in patients with SLE, which could be targeted for therapy.     

Analysis of interleukin-23 receptor (IL23R) gene polymorphisms in systemic lupus erythematosus

The aim of this study was to evaluate the association between systemic lupus erythematosus (SLE) and polymorphisms in the interleukin-23 receptor (IL23R) gene, which have been previously found to be associated with two autoimmune diseases: inflammatory bowel disease and psoriasis. Our study includes 224 SLE patients and 342 healthy controls. The genotyping of IL23R variants was carried out using a polymerase chain reaction system with predeveloped TaqMan allelic discrimination assays. No statistically significant differences were observed between SLE patients and healthy controls with any of the IL23R genetic variants. In addition, we did not find any significant differences when we stratified SLE patients according to their clinical and demographic features. These results suggest that IL23R polymorphisms do not appear to play an important role in the susceptibility or severity of SLE in the Spanish population.     

Endogenous interleukin (IL)‐17A promotes pristane‐induced systemic autoimmunity and lupus nephritis induced by pristane

Interleukin (IL)-17A is increased both in serum and in kidney biopsies from patients with lupus nephritis, but direct evidence of pathogenicity is less well established. Administration of pristane to genetically intact mice results in the production of autoantibodies and proliferative glomerulonephritis, resembling human lupus nephritis. These studies sought to define the role of IL-17A in experimental lupus induced by pristane administration. Pristane was administered to wild-type (WT) and IL-17A^−/− mice. Local and systemic immune responses were assessed after 6 days and 8 weeks, and autoimmunity, glomerular inflammation and renal injury were measured at 7 months. IL-17A production increased significantly 6 days after pristane injection, with innate immune cells, neutrophils (Ly6G⁺) and macrophages (F4/80⁺) being the predominant source of IL-17A. After 8 weeks, while systemic IL-17A was still readily detected in WT mice, the levels of proinflammatory cytokines, interferon (IFN)-γ and tumour necrosis factor (TNF) were diminished in the absence of endogenous IL-17A. Seven months after pristane treatment humoral autoimmunity was diminished in the absence of IL-17A, with decreased levels of immunoglobulin (Ig)G and anti-dsDNA antibodies. Renal inflammation and injury was less in the absence of IL-17A. Compared to WT mice, glomerular IgG, complement deposition, glomerular CD4⁺ T cells and intrarenal expression of T helper type 1 (Th1)-associated proinflammatory mediators were decreased in IL-17A^−/− mice. WT mice developed progressive proteinuria, but functional and histological renal injury was attenuated in the absence of IL-17A. Therefore, IL-17A is required for the full development of autoimmunity and lupus nephritis in experimental SLE, and early in the development of autoimmunity, innate immune cells produce IL-17A.     

Enhanced and persistent levels of interleukin (IL)‐17+CD4+ T cells and serum IL‐17 in patients with early inflammatory arthritis

Prognosis of patients with early inflammatory arthritis (EIA) is highly variable. The aim of this study was to compare, longitudinally and cross-sectionally, the levels of cytokine-expressing cells in peripheral blood (PB) from patients with EIA to those in established rheumatoid arthritis (RA) and healthy controls (HC). PB mononuclear cells from HC (n = 30), patients with EIA (n = 20) or RA (n = 38) were stimulated with phorbol myristate acetate (PMA)/ionomycin for 3 h, and stained for cell markers and cytokines. Serum cytokines and chemokines were measured by Luminex. Patients with EIA were reassessed at 6 and 12 months. The percentage of interleukin (IL)-17⁺interferon (IFN)-γ⁻CD4⁺ T cells [T helper type 17 (Th17)] was increased in RA and EIA versus HC. Serum IL-1β, IL-2, IL-4 IL-17 and macrophage inflammatory protein (MIP)-1α were increased in RA and EIA versus HC. IL-1Ra, IL-15 and IFN-α were increased in EIA versus HC. IL-6 and tumour necrosis factor (TNF)-α was increased in RA but not EIA versus HC. Disease activity scores in EIA patients improved over 12 months'' treatment. Th17 percentage at baseline was correlated with both rheumatoid factor (RF) titre and functional deficit at 12 months. Baseline levels of serum granulocyte–macrophage colony-stimulating factor (GM-CSF), IL-6 and IL-8 were correlated with Larsen score at 12 months. There were no significant changes in cytokine-expressing CD4⁺T cells over time, although the percentage of IL-6⁺ monocytes increased. IL-17⁺CD4⁺ T cells and serum IL-17 levels are increased in EIA. IL-6-expressing monocytes increase during the first year of disease, irrespective of disease-modifying anti-rheumatic drug (DMARD) therapy. We observed incomplete clinical responses, suggesting EIA patients need more intensive early therapy.     

Preferential elimination of CD28+ T cells in systemic lupus erythematosus (SLE) and the relation with activation-induced apoptosis

CD28 on T cells provides a potent costimulatory signal for T cell activation. Down-regulation of CD28 on peripheral T cells has been reported in certain clinical conditions, but full studies on the mechanism and biological significance have not been performed. Our extensive phenotype analysis of peripheral blood lymphocytes (PBL) from SLE patients revealed that the absolute number of CD28⁺ T cells of both CD4 and CD8 phenotypes was selectively decreased, while that of CD28⁻ T cells was maintained. CD28⁺ T cells from SLE patients exhibited mostly normal proliferative responses to both CD28-dependent and -independent stimulations. In contrast, CD28⁻ T cells were hyporesponsive to anti-CD3 stimulation in both SLE and normal controls. These results implied that the selective decrease of CD28⁺ T cells in SLE does not result from a hyporesponsiveness of CD28⁺ T cells. To investigate the reason for the selective loss of CD28⁺ T cells, we determined the appearance of apoptotic cells in culture with or without anti-CD3 stimulation. Apoptotic cells defined by merocyanine (MC)540 were gradually increased from 12 h to 24 h. Anti-CD3-induced apoptosis of CD28⁺ T cells was significantly accelerated in SLE, whereas apoptosis of CD28⁻ T cells was hardly detected in both SLE and normal controls. Comparative analysis between CD28⁺ and CD28⁻ T cells on CD95 (Fas) and Bcl-2 expression, which are related to activation-induced cell death (AICD), did not show a major difference, although CTLA4, which has been demonstrated to transmit an apoptosis-inducing signal, was expressed only on CD28⁺ T cells. Our results suggest that CD28-mediated costimulation influences T cell susceptibility to AICD and may be involved in T cell lymphopenia in SLE.     

Immunosuppressive therapy modulates T lymphocyte gene expression in patients with systemic lupus erythematosus

To evaluate the T-cell large-scale differential gene expression in systemic lupus erythematosus (SLE) patients presenting with glomerulonephritis we studied SLE patients before and after immunosuppressive treatment. Large-scale gene expression of peripheral blood mononuclear T cells was evaluated using cDNA microarray nylon membranes containing 5184 cDNAs. Data were analysed using the SAM and Cluster and Treeview software. When untreated patients were compared to healthy individuals, 38 genes, most of them located on chromosomes 1, 3, 6, 17 and 19, were repressed, and when untreated patients were compared to treated ones, 154 genes, located on chromosomes 1, 6, 7, 12 and 17, were induced. In terms of biological function of coded proteins, the differentially expressed genes were associated with apoptosis, cell cycle, chromosomal scaffold, cytokine/chemokine, DNA repair/replication, Golgi/mitochondrial proteins, mRNA processing, signalling molecules and tumour suppressors. Two autoantigen genes related to RNA splicing (small nuclear riboprotein 70,000 MW-U1 SNR, and splicing factor 3a, 60,000 MW), and the tetranectin-plasminogen-binding protein were repressed. The Fc fragment of immunoglobulin G low affinity IIb, apoptotic protease activating factor-1, two subunits of cytochrome c, caspase 8, complement C5a, HLA-DRA, HLA-DQB1, transforming growth factor-beta receptor II, small nuclear ribonucleoprotein polypeptide N (Sm protein N) genes, heterogeneous nuclear riboprotein-C, and argininosuccinate lyase genes, among others, were induced. A total of 10 genes were repressed in untreated patients and induced in treated ones, among them tumour necrosis factor (ligand) superfamily member 9, tumour protein p53, mannosidase alpha class IA, and CD22. Although some of these differentially expressed genes are typically expressed in B cells, CD22 and CD32 have also been reported in T cells and may provide regulatory signals to B cells. Assessment of differential gene expression may provide hybridization signatures that may identify susceptibility, diagnostic and prognostic markers of SLE.     

CD226在系统性红斑狼疮患者T淋巴细胞亚群上的表达

目的：研究CD226在SLE患者外周血T淋巴细胞亚群上的表达,以阐明CD226抗原在SLE患者体内T细胞活化中作用以及与SLE发病的关系。方法：31例SLE患者和30例健康志愿者外周血单个核细胞,在体外培养72h后,三色荧光标记的单克隆抗体染色,利用流式细胞仪测定T细胞亚群细胞表面CD226抗原的表达。结果;SLE患者组的CD3^ 、CD4^ 、CD8^ T淋巴细胞上CD226^ 表达均高于正常对照组（P＜0．01）;活动期SLE组、静止期SLE组的CD3^ 、CD4^ 、CD8^ T细胞上CD226^ 表达均显著高于对照组（P＜0．01）,而活动期与静止期患者之间T细胞亚群上CD226^ 表达则无显著性差异（P＞0．05）。SLE患者CD3^ 、CD4^ 、CD8^ T细胞CD226^ 抗原表达水平与SLEDAI之间无明显相关性（P＞0．05）。结论：SLE患者体内存在T细胞亚群异常活化;活动期、静止期SLET淋巴细胞CD226^＋表达均增高,CD226^ 可能参与了SLE的免疫发病。     

系统性红斑狼疮患者外周血CD4+和CD8+T细胞PD-1的表达和意义

目的 探讨程序性死亡分子1 (PD-1)在系统性红斑狼疮(SLE)患者外周血CD4+和CD8+T细胞上的表达及临床意义.方法 应用流式细胞仪检测51例SLE患者和38例健康对照者外周血T细胞亚群表面PD-1表达水平,比较SLE稳定组、活动组和健康对照组以及狼疮肾炎组和无狼疮肾炎组之间CD4+和CD8+T细胞表面PD-1表达的百分比,并分析其与临床表现及实验室检查数据的相关性.结果 SLE活动组CD4+T细胞PD-1表达水平高于健康对照组和不活动组,差异均有统计学意义(P＜0.05).SLE活动组、稳定组CD8+T细胞PD-1表达水平均高于健康对照组,差异有统计学意义(P＜0.05).狼疮肾炎患者CD4+PD-1+和CD8+PD-1+T细胞分别高于无狼疮肾炎患者(P＜0.01).SLE患者中抗dsDNA抗体、抗Sm抗体、抗核小体抗体阳性组外周血CD4+和CD8+T细胞PD-1表达水平均高于对应阴性组.SLE患者CD4+和CD8+T细胞PD-1表达百分率与SLE疾病活动度指数(SLEDAI)、尿蛋白定量呈正相关,与补体C3呈负相关.结论 SLE患者外周血CD4+和CD8+T细胞PD-1表达异常,与SLEDA1和自身抗体产生有明确的相关性.     

IL-10 stimulates production of platelet-activating factor by monocytes of patients with active systemic lupus erythematosus (SLE)

IL-10 displays modulatory properties on the synthesis of platelet-activating factor (PAF), a potent inflammatory mediator of vascular injury. Despite the fact that IL-10 is considered to be an anti-inflammatory cytokine, IL-10 levels correlate with disease activity in SLE. Moreover, in SLE IL-10 is unable to exert its immunosuppressive and anti-inflammatory effects. We have investigated the ability of IL-10 to stimulate PAF production from monocytes of SLE patients. Spontaneous and IL-10-stimulated PAF production by peripheral blood monocytes was measured in active (n = 13) and inactive (n = 14) SLE patients and in 15 normal control subjects. We observed that monocytes derived from patients with active SLE, but not from controls or inactive SLE, spontaneously produced significant amounts of PAF. Moreover, IL-10 enhanced the synthesis of PAF from monocytes of active SLE patients only. IL-10-induced PAF production correlated with the severity of the disease and with the extent of proteinuria. These results indicate that IL-10 only stimulates the synthesis of PAF from monocytes of SLE patients when immunologically active, suggesting that IL-10 may possess a paradoxical proinflammatory effect in SLE by promoting the production of PAF, a secondary mediator of inflammation.     

Increased frequency of the long (S) allotype of CR1 (the C3b/C4b receptor, CD35) in patients with systemic lupus erythematosus.

The allotypic forms of the C3b/C4b receptor (CR1, CD35) differ in length, in the number of expressed C3b binding sites and thus in their ability to mediate the processing of circulating C3- and C4-bearing immune complexes. We have used a combination of three informative restriction fragment length polymorphisms (RFLPs) to assess the frequencies of the F (most frequent allele comprised of four long homologous repeats (LHR)), S (five LHR) and F' (three LHR) alleles of the C3b/C4b receptor (CR1, CD35) in a French population of patients with systemic lupus erythematosus (SLE) (n = 63) and healthy controls (n = 158). A significantly higher frequency of the S phenotype was observed among patients (51%) as compared with controls (26%). The F' allele was found in 2/61 patients and 1/85 healthy controls, indicating the rare occurrence of the short CR1 allele in SLE. This allele is also extremely rare in the normal population. The overrepresentation of the S long allele among patients is indicative of a genetic linkage between CR1 and susceptibility to SLE.     

CD4+CD25+调节性T细胞与系统性红斑狼疮病情活动性关系的研究

目的：检测系统性红斑狼疮患者外周血CD4^＋CD25^＋、CD4^＋CD8^＋调节性T细胞亚群，探讨其与疾病活动性、肾脏损伤、血清抗ds-DNA抗体及免疫球蛋白和补体C3含量的关系。方法：采用流式细胞术检测北京协和医院住院和门诊SLE患者（n=37）外周血CD4^＋CD25^＋T、CD4^＋CD8^＋T细胞群比例，以15例RA和15例SS组成自身免疫性疾病对照，30例健康体检者作为正常对照，观察调节性T细胞亚群与SLE患者疾病活动性指标SLEDAI、IgG、C3及血清抗ds-DNA抗体的关系。结果：①疾病活动期SLE患者外周血CD4^＋CD25^＋调节性T细胞群比例显著低于正常对照组（P〈0.01），疾病稳定期和风湿性疾病对照组与正常对照组结果差异无统计学意义。疾病活动期和稳定期SLE患者CD4＋CD8＋T细胞群比例都略高于正常对照组，但未发现结果差异有统计学意义（P〉0.05）。②疾病活动期SLE患者外周血CD4^＋CD25^＋T细胞比例及CD4^＋CD25^＋/CD4^＋值显著低于稳定期患者（P〈0.01）。SLE患者外周血CD4^＋CD25^＋/CD4^＋值与SLEDAI、补体C3呈低度相关（r分别为-0.491、0.368，P〈0.05），CD4^＋CD25^＋T细胞数量与SLEDAI呈负相关（r=-0.578，P〈0.05）。③SLE并发肾病组外周血CD4^＋CD25^＋T细胞群比例及CD4^＋CD25^＋/CD4^＋值显著低于非肾病组（P〈0.01；P〈0.05）。同一SLE患者治疗前后CD3^＋CD4^-CD8^-细胞和NK细胞降低，CD4^＋CD25^＋细胞、CD4^＋CD25^＋/CD4^＋值及CD8^＋T细胞增加，但未发现这些结果差异有统计学意义。本次研究未发现NK细胞、CD4^＋CD8＋T细胞、CD4^＋CD25^＋T细胞群比例在ds-DNA＋组与ds-DNA-组之间结果差异有统计学意义。结论：SLE患者外周血CD4^＋CD25^＋T细胞群比例与SLEDAI成负相关，与肾脏的损害也有密切关系，但与血清抗ds-DNA抗体产生的关系不明显。活动期SLE患者外周血CD4^＋CD25^＋T细胞减少，稳定期CD4^＋CD25^＋T细胞比例回升，因此推测CD4^＋CD25^＋T细胞的变化可能是导致疾病发生和病情发展及相关器官（如肾脏）损伤的关键环节之一。     

CD4~+Foxp3~+T细胞亚群在系统性红斑狼疮中的免疫抑制功能研究

采用五色流式细胞术检测系统性红斑狼疮(systemic lupus erythematosus,SLE)患者和健康对照组的CD4+Foxp3+T细胞及其细胞亚群;以CFSE染色法分析SLE患者和健康对照组CD4+Foxp3+T细胞各亚群的免疫抑制功能。结果发现SLE组CD4+Foxp3+T细胞(占CD4+T细胞的比例)显著高于对照组(12.03%±1.523%vs 6.410%±0.4353%,t=3.790,P<0.01),但其CD4+T细胞的增殖却比对照组活跃(PI:4.052%±0.4004%vs 2.528%±0.2322%,t=3.293,P<0.05)。根据Foxp3和CD45RA表达强度的差异,可将CD4+Foxp3+T细胞清晰地分成3个亚群:CD45RA+Foxp3low(Ⅰ区)细胞、CD45RA-Foxp3high(Ⅱ区)细胞和CD45RA-Foxp3low(Ⅲ区)细胞,SLE组的Ⅰ区和Ⅲ区细胞数量显著增加(分别为t=2.123,P<0.05;t=3.462,P<0.01),而Ⅱ区细胞与对照组之间差异无统计学意义(0.6056%±0.1879%vs0.6571%±0.1764%,t=0.1999,P>0.05)。SLE患者和健康对照者的Ⅰ区和Ⅱ区细胞在体外均具有免疫抑制功能,而Ⅲ区细胞不具有该功能。SLE患者Ⅰ区细胞的免疫抑制能力弱于对照组(t=2.994,P<0.05),而Ⅱ区细胞和Ⅲ区细胞与对照组之间差异均无统计学意义。提示,SLE患者CD4+Foxp3+T细胞比例升高而免疫抑制功能下降,可能是两大原因造成了这种数量和功能的不一致性:①SLE患者CD4+Foxp3+T细胞数量增加主要由于Ⅲ区细胞增多所致,而这区细胞不具有免疫抑制功能;②在SLE患者,具有免疫抑制功能的Ⅰ区细胞的抑制能力明显减弱。     

Regulatory T cells in systemic lupus erythematosus

Systemic lupus erythematosus (SLE), an autoimmune disease, develops when immunologic self‐tolerance fails. Treg cells are a subset of CD4⁺ T cells that maintain self‐tolerance by suppressing autoreactive lymphocytes. Defects in Treg cells are therefore considered to be an aspect of SLE pathogenesis. Nevertheless, reports on the numbers and function of Treg cells in SLE are contradictory and the definitive role of Treg cells in SLE remains unclear. In this review, we summarize findings from murine models and ex vivo experiments, which provide insights into the mechanisms that result in the breakdown of tolerance. We also include recent findings about Treg‐cell subsets and their markers in human SLE. The identification of unique markers to identify bona fide Treg cells, as well as therapies to reconstitute the balance between Treg cells and autoreactive T cells in SLE, are the future challenges for SLE research.