Andreas E. R. Fasth

T Cell Infiltrates in the Muscles of Patients with Dermatomyositis and Polymyositis Are Dominated by CD28null T Cells

Dermatomyositis and polymyositis are disabling rheumatic diseases characterized by an appreciable number of T cells infiltrating muscle tissue. The precise phenotype, function and specificity of these cells remain elusive. In this study, we aimed to characterize T cells in muscle tissue and circulation and to investigate their association to clinical phenotype. Twenty-four patients with dermatomyositis and 42 with polymyositis were screened for frequency of CD4+CD28null and CD8+CD28null T cells in peripheral blood by flow cytometry. Presence of these cells in inflamed muscle tissue from 13 of these patients was analyzed by three-color immunofluorescence microscopy. Effector functions, proliferation and Ag specificity were analyzed by flow cytometry after in vitro stimulation. The clinical relevance of CD28null T cells was analyzed by multiple regression analyses including six separate and combined disease variables. We demonstrate that muscle-infiltrating T cells are predominantly CD4+CD28null and CD8+CD28null T cells in patients with dermatomyositis and polymyositis. Muscle-infiltrating CD28null T cells were found already at time of diagnosis. Disease activity correlated with the frequency of CD8+ T cells in the inflamed muscles of polymyositis patients. Circulating CD4+CD28null and CD8+CD28null T cells were significantly more frequent in human CMV (HCMV) seropositive individuals, responded to HCMV Ag stimulation, and correlated with disease duration. These cells also display a proinflammatory cytokine profile, contain perforin and lack the costimulatory molecule CD28. Our observations imply that CD28null T cells represent clinically important effector cells in dermatomyositis and polymyositis, and that HCMV might play a role in propagating disease in a subset of patients.

Skewed distribution of proinflammatory CD4+CD28null T cells in rheumatoid arthritis.

Expanded populations of CD4+ T cells lacking the co-stimulatory molecule CD28 (CD4+CD28null T cells) have been reported in several inflammatory disorders. In rheumatoid arthritis, increased frequencies of CD4+CD28null T cells in peripheral blood have previously been associated with extra-articular manifestations and human cytomegalovirus (HCMV) infection, but their presence in and contribution to joint manifestations is not clear. In the present article we investigated the distribution of CD4+CD28null T cells in the synovial membrane, synovial fluid and peripheral blood of RA patients, and analysed the association with erosive disease and anti-citrullinated protein antibodies. CD4+CD28null T cells were infrequent in the synovial membrane and synovial fluid, despite significant frequencies in the circulation. Strikingly, the dominant TCR-Vβ subsets of CD4+CD28null T cells in peripheral blood were often absent in synovial fluid. CD4+CD28null T cells in blood and synovial fluid showed specificity for HCMV antigens, and their presence was clearly associated with HCMV seropositivity but not with anti-citrullinated protein antibodies in the serum or synovial fluid, nor with erosive disease. Together these data imply a primary role for CD4+CD28null T cells in manifestations elsewhere than in the joints of patients with HCMV-seropositive rheumatoid arthritis.

Activating NK‐cell receptors co‐stimulate CD4+CD28− T cells in patients with rheumatoid arthritis

Effector T‐cell responses can be modulated by competing positive or negative signals transduced by NK‐cell receptors (NKR). In the CD4+ T‐cell population, the expression of NKR is primarily found in the CD4+CD28− T‐cell subset, also known as CD28null T cells. These T cells are frequently found in rheumatoid arthritis (RA) and other inflammatory disorders, suggesting that signaling through NKR may play a role in the autoimmune reaction. Here we aimed to dissect the phenotype and function of NKR‐expressing CD4+CD28− T cells in patients with RA. By analyzing a broad array of NKR on CD4+CD28− T cells we found a significant expression of the co‐activating receptors 2B4 (CD244), DNAM‐1 (CD226), and CRACC. Pair‐wise ligations of 2B4 with DNAM‐1 and/or NKG2D lead to increased effector functions of primary CD4+CD28− T cells to suboptimal levels of anti‐CD3 stimulation. Using multi‐parameter flow cytometry, we demonstrate that such co‐ligation led to an increased magnitude in overall responsiveness without changing qualitative aspects of the response. Altogether these results demonstrate a pattern of additive effects in NKR‐mediated functional modulation of CD4+CD28− T cells in RA. This may have consequences for the inflammatory responses imposed by these cells, thus influencing disease manifestations.

High mobility group box chromosomal protein 1 acts as a proliferation signal for activated T lymphocytes.

The nuclear protein high mobility group box chromosomal protein 1 (HMGB1) can be translocated extracellularly and plays a well-established role as a pro-inflammatory mediator during innate immune responses. Much less is known about the role of HMGB1 in adaptive immunity, since only a few studies have addressed the issue. We herein activated subsets of purified, primary human T lymphocytes with solid-phase bound anti-CD3 mAb and assessed the effects of recombinant HMGB1 protein on cell proliferation when added to the cultures. HMGB1 acted as a proliferative signal for human T cells during suboptimal anti-CD3 mAb stimulation. Statistically significant increased proliferation was recorded in both CD4+ and CD8+ T-cell cultures at HMGB1 concentrations ranging from 0.25 to 1.0 microg/ml. HMGB1 had no effect on proliferation in the absence of anti-CD3 stimulation or during T-cell activation obtained using high doses of anti-CD3 mAb. Our results demonstrate a direct HMGB1-mediated effect in adaptive immunity.

Expanded T cell receptor Vβ-restricted T cells from patients with sporadic inclusion body myositis are proinflammatory and cytotoxic CD28null T cells.

OBJECTIVE Sporadic inclusion body myositis (IBM) is characterized by T cell infiltrates in muscle tissue, but their functional role is unclear. Systemic signs of inflammation are lacking, and the absence of beneficial effects following immunosuppression has challenged the notion of a role for the immune system. This study was undertaken to investigate the phenotype and functionality of T cells, specifically a subset of proinflammatory, cytotoxic, and apoptosis-resistant T cells defined as CD28(null) T cells, in the pathogenesis of sporadic IBM. METHODS A cohort of 27 patients with sporadic IBM was analyzed for the frequency of circulating and muscle-infiltrating CD28(null) T cells. The T cell receptor (TCR) V(β) usage was determined using flow cytometry and immunohistochemistry. Anti-CD3-stimulated peripheral blood mononuclear cells were analyzed for intracellular interferon-γ and cytotoxic potential by flow cytometry. RESULTS We found striking accumulations of both CD8+CD28(null) and CD4+CD28(null) T cells, which represented the TCR V(β) -expanded T cells in sporadic IBM. Such CD28(null) T cells were abundant both in the inflamed muscle tissue and in the circulation. Although the specific TCR V(β) expansions varied between patients, both CD8+CD28(null) and CD4+CD28(null) T cells consistently displayed a highly proinflammatory and cytotoxic potential. CONCLUSION Our results suggest that CD28null T cell expansions represent the previously described expanded T cell subsets in sporadic IBM, and their proinflammatory capacity and presence in both muscle tissue and the circulation may imply a role of immune activation in sporadic IBM. In addition, CD4+CD28(null) T cells may exert cytotoxic effects directly on muscle fibers due to a cytotoxic potential similar to that in CD8+ T cells.

CD4+ and CD8+ CD28(null) T Cells Are Cytotoxic to Autologous Muscle Cells in Patients With Polymyositis.

Inflammatory T cell infiltrates in the skeletal muscle tissue of patients with polymyositis are dominated by CD28‐negative effector (CD28null) T cells of both the CD4 and CD8 lineage. These cells are potentially cytotoxic, and the aim of the present study was to develop a fully autologous cell culture system in which to investigate the functional contribution of such CD28null T cells to myotoxicity.

Activated LTB4 pathway in muscle tissue of patients with polymyositis or dermatomyositis

Objective To investigate the involvement of the leukotriene B4 (LTB4) pathway in polymyositis (PM) and dermatomyositis (DM) and the effect of immunosuppressive treatment on the LTB4 pathway. Methods 5-lipoxygenase (5-LO), 5-LO activating protein (FLAP) and LTB4 receptor-1 (BLT1) expression was analysed by immunohistochemistry in muscle tissue from patients with PM/DM before and after immunosuppressive treatment and from healthy individuals. In vivo LTB4 in thigh muscle was measured by microdialysis at rest and after acute exercise in another cohort of patients and healthy controls. Results The number of 5-LO-positive cells and BLT1-positive capillaries was higher in patients with PM/DM than in healthy individuals. The number of FLAP-expressing cells divided the patients into two groups (high/low expression). Treatment reduced the number of FLAP-positive cells in the group with initial high levels, however the expression remained high compared with healthy individuals. The number of BLT1-positive cells was also reduced while staining for 5-LO was unchanged. An inverse correlation was observed between the number of 5-LO or FLAP-positive cells in muscle tissue and muscle performance. LTB4 could be detected in dialysate of muscle tissue in vivo in both patients and healthy controls and was significantly increased after exercise in patients. Conclusion The LTB4 pathway is upregulated in muscle tissue from patients with PM/DM and this upregulation correlated negatively to muscle performance, suggesting a role for LTB4 in myositis muscle weakness. The immunosuppressive treatment was insufficient on the LTB4 pathway and, for patients with high expression of FLAP, FLAP inhibitors may be considered as possible therapy.

CD4+ and CD8+ CD28null T cells are Cytotoxic to Autologous Muscle Cells in Polymyositis Patients

Inflammatory T cell infiltrates in the skeletal muscle tissue of patients with polymyositis are dominated by CD28‐negative effector (CD28null) T cells of both the CD4 and CD8 lineage. These cells are potentially cytotoxic, and the aim of the present study was to develop a fully autologous cell culture system in which to investigate the functional contribution of such CD28null T cells to myotoxicity.

Balance between activating NKG2D, DNAM-1, NKp44 and NKp46 and inhibitory CD94/NKG2A receptors determine natural killer degranulation towards rheumatoid arthritis synovial fibroblasts.

Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation and synovial hyperplasia leading to progressive joint destruction. Fibroblast‐like synoviocytes (FLS) are central components of the aggressive, tumour‐like synovial structure termed pannus, which invades the joint space and cartilage. A distinct natural killer (NK) cell subset expressing the inhibitory CD94/NKG2A receptor is present in RA synovial fluid. Little is known about possible cellular interactions between RA‐FLS and NK cells. We used cultured RA‐FLS and the human NK cell line Nishi, of which the latter expresses an NK receptor repertoire similar to that of NK cells in RA synovial fluid, as an in vitro model system of RA‐FLS/NK cell cross‐talk. We show that RA‐FLS express numerous ligands for both activating and inhibitory NK cell receptors, and stimulate degranulation of Nishi cells. We found that NKG2D, DNAM‐1, NKp46 and NKp44 are the key activating receptors involved in Nishi cell degranulation towards RA‐FLS. Moreover, blockade of the interaction between CD94/NKG2A and its ligand HLA‐E expressed on RA‐FLS further enhanced Nishi cell degranulation in co‐culture with RA‐FLS. Using cultured RA‐FLS and the human NK cell line Nishi as an in vitro model system of RA‐FLS/NK cell cross‐talk, our results suggest that cell‐mediated cytotoxicity of RA‐FLS may be one mechanism by which NK cells influence local joint inflammation in RA.

CD28null T cells from myositis patients are cytotoxic to autologous muscle cells in vitro

Background/purpose T cells are implicated in the disease pathogenesis of dermatomyositis (DM) and polymyositis (PM) but their specificity and effector functions in the inflamed muscle remain unclear. The authors have previously demonstrated that CD28null T cells are the dominating T cell subset in affected muscle of patients with myositis. These cells are apoptosis resistant, pro-inflammatory and both CD4+CD28null and CD8+CD28null T cells from myositis patients contain perforin, hence are potentially cytolytic. Here, the authors investigated whether CD28null T cells are directly cytotoxic to autologous muscle cells in vitro. Method Autologous muscle cell - T cell co-cultures were performed in four patients with definite DM or PM and with >10% of CD4+CD28null T cells in peripheral blood. Biopsy specimens were obtained from tibialis anterior muscle. Muscle biopsies were enzymatically digested to obtain myoblasts and differentiated into myotubes. PBMC were isolated into CD4+CD28null, CD4+CD28+, CD8+CD28null and CD8+CD28+ T cell populations by flow cytometry. Before co-culturing, myotubes were labeled with calcein and T cell subsets were stimulated with mitogen PHA. The ratios used for T cells versus myotubes were mostly 5:1 and 30:1 (depending on cell yield). Co-culture supernatants were harvested after 24 h, and calcein release, mirroring muscle cell lysis (myotoxicity), was measured. The results are expressed as percentage of maximal lysis with detergent Triton X-100, and were confirmed by morphological changes. Result The authors could demonstrate myotoxicity of CD4+CD28null T cells towards autologous muscle cells (PM1, 34.5%) and the effect was dose dependent (PM2, 43.4% (low ratio), 70% (high ratio); DM1, 15%, 25%; DM2, 2%, 9%). Surprisingly, the myotoxicity of CD8+ T cells were lower than that of CD4+ T cells. Still, the authors could see a dose response also for CD8+CD28+ T cells (PM1, 12.1% (low ratio), 39% (high ratio); PM2, 11.9%, 26.8%; DM1 0.7%, 5.1%; DM2 0.6%, 3.8%). The corresponding CD28+ T cell subsets demonstrated variable myotoxicity and our preliminary data suggest that this is directly dependent on cytokine output from these populations. Overall, myotoxicity was also reflected by morphological abnormalities in myotubes. Conclusion Herein, the authors demonstrate for the first time that the muscle-dominating CD28null T cells harm autologous muscle cells from myositis patients. More experiments are needed to establish whether direct cytotoxicity or cytokine-mediated effects is the dominant pathway for myotoxicity. Irrespective of that outcome, theses data strengthen the notion that CD28null T cells may cause muscle fiber destruction and hence directly contribute to the chronic inflammation in myositis.