Abstract
T cell-mediated immune responses are thought to play an important role in the pathogenesis of anti-neutrophil cytoplasmic antibody- (ANCA-) associated vasculitides (AAV). CD4+ T cells can be divided into subsets depending on their expression of chemokine receptors. In this study, different CD4+ T cell populations in patients with AAV were analysed and compared to healthy blood donors as well as therapy controls. 18 patients with active AAV, 46 in remission, 21 healthy controls (HBD), and 15 therapy controls (TC) were enrolled. CD4+ T cells were divided into Th1, Th2, and Th17 cells and further subdivided into naïve, central memory, effector memory, and effector cells. Regulatory T cells were also analysed. Concentrations of cytokines and chemokines produced by the respective CD4+ T cell subset in plasma from 33 of the patients were measured by ELISA and compared to HBD. Clinical data were collected on all patients. CCL20 concentrations and percentages of Th17 cells (p = 0.019) were elevated in AAV patients compared to HBD. AAV patients had lower percentages of naïve CD4+ T cells (p = 0.0016) and a corresponding increase in proportion of effector memory CD4+ T cells when comparing to HBD (p = 0.027). Therapy controls showed similar results as AAV patients. In this study, we found that CD4+ T cell phenotype distribution is altered in AAV patients, in line with previously published work. However, no differences were found between AAV patients and TC, stressing the importance of treatment impact on this kind of studies.
Highlights
The anti-neutrophil cytoplasmic autoantibody- (ANCA-) associated vasculitides (AAV) are a group of autoimmune diseases characterized by necrotizing inflammation predominantly in small blood vessels and comprise granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA) [1, 2]
We found that AAV patients had lower percentages of naïve CD4+ T cells than healthy blood donors (HBD) (Figure 1)
A corresponding increase in the proportion of effector memory (EM) CD4+ T cells was detected in AAV patients compared with HBD (p = 0 027)
Summary
The anti-neutrophil cytoplasmic autoantibody- (ANCA-) associated vasculitides (AAV) are a group of autoimmune diseases characterized by necrotizing inflammation predominantly in small blood vessels and comprise granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA) [1, 2]. GPA and MPA have a strong association with ANCA, GPA predominantly with ANCA targeting proteinase 3 (PR3-ANCA), and MPA with ANCA against myeloperoxidase (MPO-ANCA) [3]. AAV often presents clinically as a systemic disease. The pathogenicity of PR3-ANCA and MPO-ANCA is debated, but it is likely that these autoantibodies to some, perhaps varying, extent are pathogenic. Activation of the complement system, especially through the alternative pathway, is thought to contribute to the vasculitis process [5, 6]
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