Clinicopathological Manifestations and Immune Phenotypes in Adult-Onset Immunodeficiency with Anti-interferon-γ Autoantibodies.

Yi-Chun Chen,Shao-Wen Weng,Huey-Ling You,Wen-Chi Huang,Jing-Ya Ding,Wan-Ting Huang,Chen-Hsiang Lee,Cheng-Lung Ku

doi:10.1007/s10875-022-01210-y

Abstract

Anti-interferon (IFN)-γ autoantibodies (anti-IFN-γ Abs) is an emerging adult-onset immunodeficiency syndrome. Immune dysfunction in this distinct disorder remains to be clarified. We prospectively collected blood samples of 20 patients with anti-IFN-γ Abs and 40 healthy normal subjects. The percentages of lymphocyte subpopulations, most relevant to T, B, and NK cells, and the percentages of stimulated lymphocytes with cytokine production were assessed using eight-color flow cytometry. The results were adjusted to age and absolute lymphocyte counts. Most (85%) patients presented nontuberculous mycobacterial infection. Skin lesions were predominantly manifested by neutrophilic dermatoses. The involved lymph nodes had granulomatous inflammation, except 22.2% showing atypical lymphoid hyperplasia without granuloma formation. The percentages of CD4 + T cells and nonactivated subpopulations (recent thymic emigrants and naïve subtypes) decreased significantly with increased expression of activation markers and polarization to differentiated cells. The percentage of NK cells increased, but that of two major NK subpopulations, CD161 + CD56bright and CD161 + CD56 + CD16 + subsets, decreased. Increased CD161dim, CD161 + CD56 - CD16 + , and CD57 + NK cell subsets coupled with the decreased expression of NKp30 and NKp46 indicate reconfiguration of the NK cell population and acquisition of adaptive features. Intracellular cytokine production of the lymphocyte subpopulations was significantly low in the patients compared with the control group. We conclude that the immune system in patients with anti-IFN-γ Abs could be exhausted in T cells and be adaptive in NK cells, contributing to the distinct clinicopathologic features.

Highlights

Adult-onset immunodeficiency due to anti-interferon (IFN)-γ autoantibodies is a distinct disorder, recently emerging in Southeast Asia [1, 2]
Skin lesions were predominantly manifested by neutrophilic dermatoses
Intracellular cytokine production of the lymphocyte subpopulations were significantly low in the patients compared with the control group

Summary

Introduction

Adult-onset immunodeficiency due to anti-interferon (IFN)-γ autoantibodies (anti-IFN-γ Abs) is a distinct disorder, recently emerging in Southeast Asia [1, 2]. Far more than 600 patients with anti-IFN-γ Abs have been described [3, 4]. Almost all patients are adults aged 30–70 years with no sex predominance [1, 3]. Neutralizing anti-IFN-γ Abs are responsible for the increased susceptibility to infections of nontuberculous mycobacteria (NTM) and intracellular pathogens. Reactive conditions such as skin manifestation were frequent, with reactive skin disorders, mostly neutrophilic dermatoses, reported in 82% of the patients [6]. Diagnosis of the disease is difficult owing to the protean manifestations in apparently immunocompetent hosts and the absence of standard laboratory assays [7, 8]. Patients may require long-term antimycobacterial therapy because of chronic infections and high recurrence rates, even after remission [9, 10]

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Discussion

Conclusion