Defective T-helper cell function after T-cell–depleting therapy affecting naive and memory populations

A Heitger, P Winklehner, P Obexer… - Blood, The Journal …, 2002 - ashpublications.org
A Heitger, P Winklehner, P Obexer, J Eder, C Zelle-Rieser, G Kropshofer, M Thurnher
Blood, The Journal of the American Society of Hematology, 2002ashpublications.org
Impaired T-cell function after T-cell–depleting (TCD) therapy has been hypothesized to be
related to a transient predominance of extrathymically expanding memory T cells. To test
whether after TCD therapy the naive T-helper cell population is functionally intact, the in vitro
immune response of CD4+ CD45RA+ (naive) and of CD4+ CD45RA−(memory) cells to
polyclonal mitogens (immobilized anti-CD3, phytohemagglutinin) was analyzed by flow
cytometry in 22 pediatric patients after high-dose chemotherapy (including 5 after …
Impaired T-cell function after T-cell– depleting (TCD) therapy has been hypothesized to be related to a transient predominance of extrathymically expanding memory T cells. To test whether after TCD therapy the naive T-helper cell population is functionally intact, the in vitro immune response of CD4+CD45RA+ (naive) and of CD4+CD45RA (memory) cells to polyclonal mitogens (immobilized anti-CD3, phytohemagglutinin) was analyzed by flow cytometry in 22 pediatric patients after high-dose chemotherapy (including 5 after autologous and 5 after allogeneic stem cell support). At 1 to 3 months after TCD therapy, patient samples showing decreased lymphoproliferative responses also showed a reduced induction of the early activation marker CD69 by CD4+ T cells from 4 to 72 hours after stimulation even when supplemented with exogenous interleukin-2. This defect affected CD4+CD45RA cells, but, strikingly, also CD4+CD45RA+ cells, including samples in which CD4+CD45RA+ cells were more than 90/μL, thus indicating ongoing thymopoiesis. Histogram analyses showed the median peak channel of CD69 in control CD4+CD45RA+cells rising 98-fold (median) but only 28-fold in patient cells (P < .0001). Apoptosis as detected by annexin V staining was increased in resting patient CD4+ T cells (25% versus 6%) and also affected CD4+CD45RA+ cells (12% versus 5%, P < .01). When peripheral blood mononuclear cells (PBMCs) were enriched for T cells, stimulatory responses of CD4+ cells and of CD4+CD45RA+ cells markedly improved. Thus, after TCD therapy suppressor factors contained in the non–T-cell fraction of PBMCs may affect T-helper cells irrespective of their naive or memory phenotype thus extending T-cell dysfunction to the presumably thymus-dependently regenerated T cells.
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