Clinical and Genetic Characterization of Japanese Sporadic Cases of Periodic Fever,Aphthous Stomatitis,Pharyngitis and Adenitis Syndrome from a Single Medical Center in Japan

Purpose

To investigate clinical presentation, genetic background and cytokine profile of Japanese sporadic cases of periodic fever, aphthous stomatitis, pharyngitis and adenitis (PFAPA) syndrome.

Methods

Nine PFAPA syndrome patients were recruited. DNA sequence analysis of auto inflammatory disorder susceptibility genes, MEFV, MVK, NLRP3, and TNFRSF1A, were performed. Serum cytokine levels and monocyte IL-1β levels were measured by ELISA.

Results

The study population consisted of six males and three females (mean age of onset 26.8 months). Febrile episodes lasted 3–6 days with symptom-free intervals ranging from 2 to 12 weeks. Fever was accompanied by pharyngitis (n?=?8), aphthous stomatitis (n?=?4), and cervical adenitis (n?=?5). White blood cells and C-reactive protein were increased during the attack phase. Mean IgD serum levels were 7.32?±?9.51 mg/dl during the attack phase, and were mildly elevated in two patients. Heterozygous MEFV, NLRP3 and TNFRSF1A variants were detected in four, one and three cases, respectively. Serum TNF-α and IL-18 levels were elevated during the attack-free and attack periods compared with controls. Other cytokines, IL-1β, IL-1ra, IL-6, and sTNFR1, were only increased during the attack phase. Oral prednisolone was administered to eight patients and immediately reduced fever. Tonsillectomy performed in five patients induced cessation of fever in four patients. One case with repeated fever attacks after tonsillectomy showed increased monocyte IL-1β production, similar to the other active case with genetic variants of auto inflammatory disorder-associated genes.

Conclusions

Japanese PFAPA syndrome patients may have cytokine regulation dysfunction as a result of genetic variants of auto inflammatory disorder-associated genes.     

Microbes of the tonsils in PFAPA (Periodic Fever,Aphtous stomatitis,Pharyngitis and Adenitis) syndrome – a possible trigger of febrile episodes

Periodic Fever, Aphtous stomatitis, Pharyngitis, and Adenitis (PFAPA) is a childhood febrile syndrome that is often cured by tonsillectomy (TE). We hypothesized that microbes present in the tonsils may act as a trigger for the activation of inflammasomes and investigated the microbiology of the tonsils in PFAPA patients and controls. We recruited 31 consecutive children who underwent TE due to PFAPA; 24 children who underwent TE due to other reasons served as controls. We cultured all the samples for bacteria, mycobacteria, yeasts, and viruses and used PCR for 15 viruses. Also biofilm formation and histologic findings were identified. The samples of the patients yielded Candida albicans more often than did the controls (16 vs 0%, p = 0.003). Staphylococcus aureus occurred in only 10% of the patients, but in 38% of the controls (p = 0.01). Varicella zoster and Herpes simplex viruses occurred less often in patients than in controls. Biofilm was present in 55% of PFAPA tonsils, but in only 24% of the controls (p = 0.03). The microbes found in the tonsils of PFAPA patients showed significant differences from those of controls. This may in part explain the efficacy of TE in PFAPA.     

Identification of Germinal Centres in the Lymph Node of a Patient with Hyperimmunoglobulin M Syndrome Associated with Congenital Rubella

Background

The hyper immunoglobulin M syndrome (HIM) associated with congenital rubella infection (rHIM) is an extremely rare disorder, where patients have elevated serum IgM in association with reduced IgG and IgA. We have previously shown that in contrast to X-linked HIM (XHIM), a patient with well-characterised rHIM is able to express functional CD40 ligand, undergo immunoglobulin isotype switching and to generate memory B cells. Here we describe the ultrastructural features of an excised lymph node from this patient.

Methods

An inguinal lymph node was surgically removed and examined histologically as well as by immunohistochemistry. It was then stained with multiple fluorescent dyes to visualize the cellular interactions within the node. Flow cytometry was undertaken on a cellular suspension from the node.

Findings

Our patient has normal lymph node architecture by light microscopy. Immunohistochemistry studies showed the presence of scattered germinal centres. Polychromatic immunofluorescence staining showed disruption of the architecture with mostly abnormal germinal centres. A small number of relatively intact germinal centres were identified. Both IgM and IgG bearing cells were identified in germinal centres.

Interpretation

In contrast to XHIM where germinal centres are absent, the presence of small numbers of relatively normal germinal centres explain our previous identification of isotype switched memory B cells in rHIM.     

Regulators of Glucose Metabolism in CD4+ and CD8+ T Cells

Much like cancer cells, activated T cells undergo various metabolic changes that allow them to grow and proliferate rapidly. By adopting aerobic glycolysis upon activation, T cells effectively prioritize efficiency in biosynthesis over energy generation. There are distinct differences in the way CD4⁺ and CD8⁺ T cells process activation signals. CD8⁺ effector T cells are less dependent on Glut1 and oxygen levels compared to their CD4⁺ counterparts. Similarly the downstream signaling by TCR also differs in both effector T cell types. Recent studies have explored PI3K/Akt, mTORC, HIF1α, p70S6K and Bcl-6 signaling in depth providing definition of the crucial roles of these regulators in glucose metabolism. These new insights may allow improved therapeutic manipulation against inflammatory conditions that are associated with dysfunctional T-cell metabolism such as autoimmune disorders, metabolic syndrome, HIV, and cancers.     

Reduced Frequencies and Heightened CD103 Expression among Virus-Induced CD8+ T Cells in the Respiratory Tract Airways of Vitamin A-Deficient Mice

Vitamin A deficiency (VAD) has profound effects on immune responses in the gut, but its effect on other mucosal responses is less well understood. Sendai virus (SeV) is a candidate human parainfluenza virus type 1 (hPIV-1) vaccine and a candidate vaccine vector for other respiratory viruses. A single intranasal dose of SeV elicits a protective immune response against hPIV-1 within days after vaccination. To define the effect of VAD on acute responses toward SeV, we monitored both antibodies and CD8⁺ T cells in mice. On day 10 following SeV infection, there was a trend toward lower antibody activities in the nasal washes of VAD mice than in those of controls, while bronchoalveolar lavage (BAL) fluid and serum antibodies were not reduced. In contrast, there was a dramatic reduction of immunodominant CD8⁺ T cell frequencies in the lower respiratory tract (LRT) airways of VAD animals. These T cells also showed unusually high CD103 (the αE subunit of αEβ7) expression patterns. In both VAD and control mice, E-cadherin (the ligand for αEβ7) was better expressed among epithelial cells lining the upper respiratory tract (URT) than in LRT airways. The results support a working hypothesis that the high CD103 expression among T cell populations in VAD mice alters mechanisms of T cell cross talk with URT and LRT epithelial cells, thereby inhibiting T cell migration and egress into the lower airway. Our data emphasize that the consequences of VAD are not limited to gut-resident cells and characterize VAD influences on an immune response to a respiratory virus vaccine.     

洛伐他汀对急性冠脉综合征患者CD4~+ CD25~+ CD127~- T细胞的影响

目的:探讨洛伐他汀治疗急性冠脉综合征(ACS)患者时外周血CD4+ CD25+ CD127-调节性T细胞(Treg)数量的变化及炎症反应状况。方法:将40例ACS患者随机分为常规治疗组(20例)和常规治疗加洛伐他汀治疗组(20例),分别于治疗前及治疗4周后取外周血,用流式细胞术检测各组CD4+ CD25+ CD127-细胞的百分率;并用ELISA测定循环血中细胞因子水平。结果:与正常对照组比较,ACS患者Treg百分比明显偏低(P<0.01),血清C反应蛋白(CRP)水平较高,转化生长因子-β(TGF-β)和白介素-10(IL-10)水平则偏低。治疗4周后,常规加洛伐他汀治疗组患者Treg百分比明显上升(P<0.01),血清TGF-β和IL-10水平升高,CRP明显下降;而常规治疗组无明显变化;Treg数量与TGF-β和IL-10水平呈正相关,而与CRP水平呈负相关。结论:Treg数量减少可能是ACS患者炎症反应增强和斑块失稳定的重要机制;他汀类药物的抗炎作用及稳定斑块作用可能通过影响Treg的途径实现。     

肺炎支原体感染患儿外周血CD4+CD25+调节性T细胞的变化及其临床意义

探讨肺炎支原体(MP)感染患儿外周血CD4+ CD25+调节性T细胞(Treg)频率变化及其意义.选取32例肺炎支原体感染患儿,其中肺炎支原体肺炎18例,肺炎支原体肺炎合并肺外症状14例;26名健康儿童,分离其外周血单个核细胞,以CD4、CD25单克隆抗体标记细胞后,用流式细胞仪(FACS)检测Treg细胞频率.FAC...     

Concentrations of Soluble CD95 and CD8 Antigens in the Plasma and Levels of CD8+CD95+, CD8+CD38+, and CD4+CD95+ T Cells Are Markers for HIV-1 Infection and Clinical Status

Apoptosis mediated via the CD95 (FAS/APO-1) receptor is thought to play a role in the depletion of CD4+ T cells in HIV infection. In the present study expression of the CD95 antigen on lymphocyte subsets and the plasma level of soluble CD95 (sCD95) were determined in HIV-1-infected adults. The expression of CD95 was increased on CD8 cells in all groups of HIV+ individuals, while increased expression of CD95+ cells on CD4 cells was limited to individuals with CD4 counts of <200 mm³. The proportion of CD4+ that expressed CD95 was inversely correlated with the percentage of CD4+ PBL. The concentration of sCD95 was significantly higher in the plasma of HIV-infected individuals than in normal controls. The level of sCD95 in HIV-infected subjects showed no correlation with the percentage of PBL expressing CD95, indicating that the increased level of sCD95 did not reflect release from CD95+ PBL. The plasma sCD95 concentration was significantly correlated with the percentage of CD8+ cells and, particularly, with CD8+CD38– cells. A striking inverse correlation was found between the sCD95 plasma concentration and the proportion of CD4+CD95+ cells out of the total CD4+ population. There was no correlation between the serum level of sCD95 and that of soluble CD8 (sCD8), both of which were increased in the plasma of HIV+ individuals. Unlike the level of sCD95, the level of sCD8 in the plasma of HIV+ individuals. Unlike the level of sCD95, the level of sCD8 in the plasma of HIV+ individuals was correlated with the percentage of CD95+ and CD8+CD38+ cells. The present study indicates that plasma sCD95 may be one of the factors that regulate apoptotic death of lymphocytes in HIV infection.     

Role of CD4+ and CD8+ T Cells in Clearance of Primary Pulmonary Infection with Coxiella burnetii

The mechanisms of the primary adaptive immune response to Coxiella burnetii are not well known. Following inoculation of the lungs with C. burnetii Nine Mile phase I (NMI), SCID mice developed pneumonia and splenomegaly and succumbed to infection, whereas wild-type mice cleared the infection by 24 days. SCID mice reconstituted with either CD4⁺ T cells or CD8⁺ T cells alone were able to control the infection, indicating that the presence of either type of T cells was sufficient to control infection, and B cells were not necessary for primary immunity. Similarly, wild-type mice depleted of either CD4⁺ T cells or CD8⁺ T cells controlled infections in their lungs, but these mice were highly susceptible if they were depleted of both types of T cells. However, compared to CD4⁺ T-cell-dependent protection, CD8⁺ T-cell-dependent protection resulted in less inflammation in the lungs and less growth of bacteria in the spleens.Coxiella burnetii, the etiologic agent of Q fever, is thought to be a widely underdiagnosed cause of pneumonia. Acute infections with this organism commonly result in a self-limiting, febrile illness with pulmonary involvement, reflecting the typical acquisition of the infection by the aerosol route. Complications associated with such infections include development of a chronic phase in certain susceptible individuals which presents as endocarditis and has a high fatality rate in the absence of appropriate treatment. Interest in this organism has recently been piqued by its inclusion on the list of potential bioterror agents. Notwithstanding the relatively low mortality rate associated with C. burnetii infections, this organism is highly infectious and has the capacity to cause significant morbidity (16, 23).Two phase variants C. burnetii have been found; phase I is highly virulent and is the naturally occurring variant, and phase II occurs following repeated passage through cell cultures. The two phases differ in lipopolysaccharide (LPS) structure. Phase I C. burnetii encodes a complete LPS with an O side chain, while phase II C. burnetii expresses a truncated LPS lacking the O side chain and some additional sugar residues (10). Andoh et al. (2) examined the comparative virulence of the two variants in SCID and immunocompetent mice using the intraperitoneal (i.p.) route of inoculation and demonstrated that some replication of C. burnetii Nine Mile phase II (NMII) took place in immunocompromised mice but not in immunocompetent mice. This finding suggests that an acquired immune system is required for control of infection with this organism (3).Aerosols are thought to be the most common cause of transmission of Coxiella to humans and other mammals. However, very little is known about the effects of this route of infection at the cellular level. To date, most studies using animal models of C. burnetii infection have utilized the intraperitoneal (i.p.) route of inoculation, and while these studies have provided important data, this route of infection may not entirely reproduce the pulmonary sequelae of most human infections (3). Studies of pulmonary Coxiella infection in guinea pigs (15) and in BALB/c and SCID mice (21) demonstrated that lymphocytes accumulate early during primary lung infection. However, the subsets of lymphocytes elicited in the primary pulmonary response and the role of each subset were not clearly defined. The availability of a protective vaccine against C. burnetii has enabled studies of the immune response to postvaccine Coxiella challenge, which showed that the adaptive immune response is involved in successful resolution of postvaccination Coxiella infections. Indeed, studies using vaccination models have suggested that the predominant immune response to i.p. infection is T cell mediated (12). Immunized B-cell-deficient mice are capable of clearing i.p. delivered C. burnetii NMI, although the mice exhibit histopathological changes, suggesting that B cells may be important for controlling inflammatory damage during a secondary response, possibly through production of interleukin-10 (IL-10) (3).     

Decreased Levels of Circulating CD4+CD25+Foxp3+ Regulatory T Cells in Patients with Primary Antiphospholipid Syndrome

Introduction

CD4⁺CD25⁺Foxp3⁺ regulatory T (Treg) cell dysfunction has been documented in various autoimmune disorders, but not in antiphospholipid syndrome (APS) so far.

Methods

In this cross-sectional study, we aim to investigate CD4⁺CD25⁺Foxp3⁺ Treg cells, CD3⁺CD19^? T cells and CD3^?CD19⁺ B cells in patients with primary APS and healthy controls. Cell subtypes were immunophenotyped using specific monoclonal antibodies (anti-CD3 CY5, anti-CD4 FITC, anti-CD25, anti-Foxp3, anti-CD19 PE) and flow cytometry.

Results

Twenty patients with APS and 20 age- and sex-matched controls were studied. The percentage of total lymphocytes, activated Th cells (CD4+CD25+), Treg cells and CD3^?CD19⁺ B cells were found significantly lower in APS patients as compared to controls (all p?<?0.05).

Conclusion

A dysfunction in CD4⁺CD25⁺Foxp3⁺ Treg cells may represent one of the mechanisms leading to autoimmunity in APS patients. The decreased number of CD3^?CD19⁺ B cells of APS patients warrants further elucidation.     

CD38brightCD8+ T Cells Associated with the Development of Acute GVHD Are Activated,Proliferating, and Cytotoxic Trafficking Cells

We have previously reported that a peripheral blood absolute CD38^brightCD8⁺ effector memory T cell (TEM) population expansion of >35 cells/µL predicts the development of acute graft-versus-host disease (GVHD). We hypothesized that these T cells are activated, proliferating, and cytotoxic trafficking cells that are not a response to viral reactivation and may be involved in acute GVHD. We characterized peripheral blood T cell populations at the time of maximum CD38^brightCD8⁺ TEM expansion in patients from our originally reported pediatric allogeneic hematopoietic cell transplantation recipient cohort. Samples were incubated with fluorochrome-conjugated antibodies directed against CD3, CD8, CD38, HLA-DR (T cell activation), Ki-67 (T cell proliferation), granzyme B (marker of cytotoxic T cells), CLA (skin trafficking), CCR5 (visceral trafficking), and CXCR6 (liver trafficking). We also incubated samples with Epstein-Barr virus (EBV) and cytomegalovirus (CMV) peptide pools and measured IFN-γ production by flow cytometry and performed EBV and CMV tetramer staining. Higher median proportions of cell expression of HLA-DR, Ki-67, granzyme B, CLA, CCR5, and CXCR6 were observed for CD38^brightCD8⁺ T cells compared with CD38^nonbrightCD8⁺ T cells in patients with acute GVHD (P < .05) but not in patients without acute GVHD (P not significant). No IFN-γ production was observed after incubation with CMV and EBV peptide pools. EBV-specific tetramer populations of 6.85% and 3.17% were detected in 2 patients with acute GVHD, whereas a CMV-specific tetramer population of 3.77% was detected in 1 patient with acute GVHD. No EBV- or CMV-specific tetramer populations were detected in any patient without acute GVHD. We conclude that CD38^brightCD8⁺ T cells associated with the development of acute GVHD are activated, proliferating, and cytotoxic trafficking cells that do not appear to respond to CMV or EBV reactivation. Further studies are needed to determine whether these cells are directly involved in acute GVHD pathogenesis.     

Imbalance of the CD4+ Subpopulations Expressing CD45RA and CD29 Antigens in the Peripheral Blood of Adults and Children with Down Syndrome

Peripheral blood lymphoid subsets expressing either CD45RA or CD29 antigens, were quantified in 30 children and 59 adults with Down Syndrome and appropriate age-matched controls, by dual immunofluorescence and flow cytometry, Down's patients, both adults and children, displayed a significant decrease of CD4⁺CD45RA⁺ cells in comparison with the observed in their age-matched controls, but no difference was found in the CD4⁺CD29⁺ subset. These results show clearly the imbalance of these subpopulations in the peripheral blood of individuals with Down syndrome that result in the inversion of the CD45RA/CD29 ratio, due to a major reduction of the CD45RA subset. No obvious diflerence was found in the CD45RA/CD29 ratio within the CD4 negative cells. Abnormalities of these subpopulations could be indicative of early senescence of the immune system, since age-related changes in Down's persons were in parallel with those observed in normal individuals and the proportion of both subpopulations were roughly similar in Down's children and normal adults.     

Dichotomy of two CD8+ lymphocyte subsets in HIV infection. Depletion of CD8+ CD3- and expansion of CD8+ CD3+ subsets: consequence on the CD4/CD8 ratio.

In order to highlight the underlying mechanism(s) of the CD8 lymphocyte expansion in the HIV infection, two distinct CD8 subsets were analysed: T CD8bright+ CD3+ with MHC-restricted activity, and non-T CD8dim+ CD3-, which performs natural killer (NK) activity. It consists of a cross-sectional study including 168 HIV-infected patients (74 CDC stage II, 48 CDC stage III and 46 CDC stage IV) compared among them and to 60 healthy individuals. We observed an expansion of CD8+ CD3+ cells which masks a depletion of CD8+ CD3-. The comparative study showed that the expansion of the CD8+ CD3+ is relatively higher than that of total CD8+ lymphocytes and that the depletion of the CD8+ CD3- subset is severe, begins early and remains constant through the HIV progression. The comparison of CD4/CD8 and CD4/CD8+ CD3+ ratios showed that the latter could possibly be a better indicator in the HIV infection. The mechanism of inverted CD4/CD8 ratio in healthy individuals was also clarified. The CD8+ CD3+, CD8+ CD3- and CD4/CD8+ CD3+ parameters would be more specific markers than total CD8 and CD4/CD8 ratio especially in therapy trials.     

Ill-Defined Germinal Centers and Severely Reduced Plasma Cells are Histological Hallmarks of Lymphadenopathy in Patients with Common Variable Immunodeficiency

Given the severely reduced numbers of circulating class-switched memory B cells and plasmablasts in patients with common variable immunodeficiency (CVID) the germinal center (GC) reaction as the source of both populations is expected to be disturbed in many CVID patients. Therefore immunohistochemical studies were performed on lymph node (LN) biopsies from ten CVID patients with benign lymphoproliferation. According to the Sander classification the majority of patients presented with reactive lymphoid hyperplasia (7/10), 6/10 showed granulomatous inflammation. All cases showed some normal GCs but in 9/10 these concurred to a varying degree with hyperplastic, ill-defined GCs in the same LN. The percentage of ill-defined GCs correlated significantly with the percentage of circulating CD21^low B cells suggesting a common origin of both immune reactions. In 9/10 CVID LNs significantly higher numbers of infiltrating CD8⁺ T cells were found in GCs of CVID patients compared to controls, but no HHV-8 and only in 2/10 LNs EBV infection was detected. Class switched plasma cells (PCs) were severely reduced in 8/10 LNs and if present, rarely found in the medulla of the LN. Based on the presence of large GCs in all examined patients, the reduction of circulating memory B cells and PCs points towards a failure of GC output rather than GC formation in CVID patients with lymphadenopathy.     

Protective and Pathological Functions of CD8+ T Cells in Leishmania braziliensis Infection

Cutaneous leishmaniasis (CL) caused by Leishmania braziliensis is characterized by a strong Th1 response that leads to skin lesion development. In areas where L. braziliensis transmission is endemic, up to 15% of healthy subjects have tested positive for delayed-type hypersensitivity to soluble leishmania antigen (SLA) and are considered to have subclinical (SC) infection. SC subjects produce less gamma interferon (IFN-γ) and tumor necrosis factor alpha (TNF-α) than do CL patients, but they are able to control the infection. The aim of this study was to characterized the role of CD8⁺ T cells in SC infection and in CL. Peripheral blood mononuclear cells (PBMC) were stimulated with SLA to determine the frequencies of CD4⁺ IFN-γ⁺ and CD8⁺ IFN-γ⁺ T cells. Monocytes from PBMC were infected with L. braziliensis and cocultured with CD8⁺ T cells, and the frequencies of infected monocytes and levels of cytotoxicity markers, target cell apoptosis, and granzyme B were determined. The frequency of CD8⁺ IFN-γ⁺ cells after SLA stimulation was higher for SC individuals than for CL patients. The frequency of infected monocytes in SC cells was lower than that in CL cells. CL CD8⁺ T cells induced more apoptosis of infected monocytes than did SC CD8⁺ T cells. Granzyme B production in CD8⁺ T cells was higher in CL than in SC cells. While the use of a granzyme B inhibitor decreased the number of apoptotic cells in the CL group, the use of z-VAD-FMK had no effect on the frequency of these cells. These results suggest that CL CD8⁺ T cells are more cytotoxic and may be involved in pathology.     

Inhibition of Alloantigen‐Primed Memory CD4+ and CD8+ T Cells by Hematopoietic Chimerism in Mice

Donor‐reactive memory T cells present a special hurdle in transplantation. Although hematopoietic chimerism is effective for inducing donor‐specific tolerance, the effects on memory T cells are unclear. Here, we induced stable chimerism and tolerance in mice (Tolerance group, n = 6) by donor‐specific transfusion (DST) plus anti‐CD154 monoclonal antibody (mAb), avoiding the toxic myeloablative conditioning treatment to assist bone marrow transplantation (DST/aCD154&BMTx). We then transferred memory CD4⁺ or CD8⁺ T cells from donor antigen primed mice to the tolerance‐induced recipients 4 days after heart transplantation (Tol/CD4⁺ Tm group and Tol/CD8⁺ Tm group, n = 6, respectively), but neither of these memory T‐cell subsets had an effect on the permanent graft survival (median survival time > 100 days). The unaltered rate of memory T cells in spleen and anergy to donor antigen in vitro demonstrated that these memory T cells were well controlled. The chimerism‐promoting protocol DST/aCD154&BMTx produced an immune environment that included high levels of regulatory T cells (Tregs), microchimerism and TGF‐β, all of which may act in suppressing the donor‐reactive memory CD4⁺ or CD8⁺ T cells. These findings have potentially important implications for designing approaches to suppressing memory T cells for success of transplantation.