Evidence for Translocation of Microbial Products in Patients with Idiopathic CD4 Lymphocytopenia

National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
The Journal of Infectious Diseases (Impact Factor: 6). 07/2009; 199(11):1664-70. DOI: 10.1086/598953
Source: PubMed


Translocation of microbial products has been described in chronic human immunodeficiency virus (HIV) infection and correlates with activation of the immune system. We investigated the potential translocation of microbial products in idiopathic CD4 lymphocytopenia (ICL), a rare disorder characterized by low CD4 T cell counts in the absence of HIV infection. Plasma lipopolysaccharide (LPS) levels and T cell activation were measured in a cross-sectional cohort study of patients with ICL and HIV infection and healthy control subjects. Increases in CD4 T cell proliferation but not CD8 T cell proliferation were observed in patients with ICL. LPS levels were significantly elevated both in patients with ICL and in patients with HIV infection, and they were strongly correlated with the proportion of proliferating CD4 T cells in the cohort of patients with ICL (r = 0.88; P= .003). The proportions of T helper (Th) 17 and Th1 CD4 cells in peripheral blood were similar between patients with ICL, patients with HIV infection, and control subjects. These findings suggest a potential association of translocation of microbial products with perturbed CD4 T cell homeostasis in individuals with CD4 lymphopenic states other than HIV infection.

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    • "First, increased activation of CD4, which may result from stimulation by an unidentified pathogen, resulting in a persistent decrease in the number of CD4+ lymphocytes.[2] Lee et al. found increased levels of serum lipopolysaccharide (LPS) and markers of CD4+ lymphocyte activation in patients with ICL. Therefore, they hypothesized that abnormally increased microbial translocation through the intestinal wall may be an underlying etiology.[146] Second, apoptosis of CD4+ lymphocyte may be associated with enhanced expression of Fas and Fas ligand. "
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    ABSTRACT: Idiopathic CD4 lymphocytopenia (ICL) was first defined in 1992 by the US Centers for Disease Control and Prevention (CDC) as the repeated presence of a CD4+ T lymphocyte count of fewer than 300 cells per cubic millimeter or of less than 20% of total T cells with no evidence of human immunodeficiency virus (HIV) infection and no condition that might cause depressed CD4 counts. Most of our knowledge about ICL comes from scattered case reports. The aim of this study was to collect comprehensive data from the previously published cases to understand the characteristics of this rare condition. We searched the PubMed database and Science Direct for case reports since 1989 for Idiopathic CD4 lymphocytopenia cases. We found 258 cases diagnosed with ICL in 143 published papers. We collected data about age, sex, pathogens, site of infections, CD4 count, CD8 count, CD4:CD8 ratio, presence of HIV risk factors, malignancies, autoimmune diseases and whether the patients survived or died. The mean age at diagnosis of first opportunistic infection (or ICL if no opportunistic infection reported) was 40.7 ± 19.2 years (standard deviation), with a range of 1 to 85. One-sixty (62%) patients were males, 91 (35.2%) were females, and 7 (2.7%) patients were not identified whether males or females. Risk factors for HIV were documented in 36 (13.9%) patients. The mean initial CD4 count was 142.6 ± 103.9/mm(3) (standard deviation). The mean initial CD8 count was 295 ± 273.6/mm(3) (standard deviation). The mean initial CD4:CD8 ratio was 0.6 ± 0.7 (standard deviation). The mean lowest CD4 count was 115.4 ± 87.1/mm(3) (standard deviation). The majority of patients 226 (87.6%) had at least one infection. Cryptococcal infections were the most prevalent infections in ICL patients (26.6%), followed by mycobacterial infections (17%), candidal infections (16.2%), and VZV infections (13.1%). Malignancies were reported in 47 (18.1%) patients. Autoimmune diseases were reported in 37 (14.2%) patients.
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    • "Direct consequences of CD4+ T cell loss, such as the reactivation of opportunistic pathogens, or microbial translocation due to the depletion of Th17 cells in the gut mucosa, likely contribute to chronic immune activation in ICL, in a pattern comparable to that seen in HIV infection [53]. Indeed, microbial translocation products can be detected in the plasma of ICL patients [13]. The lower IL-2 responses in ICL patients may also fuel immune activation through reduced Treg suppressive activity, as discussed above. "
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    ABSTRACT: Idiopathic CD4 lymphocytopenia (ICL) is a rare immune deficiency characterized by a protracted CD4(+) T cell loss of unknown etiology and by the occurrence of opportunistic infections similar to those seen in AIDS. We investigated whether a defect in responses to cytokines that control CD4(+) T cell homeostasis could play a role in ICL. Immunophenotype and signaling responses to interleukin-7 (IL-7), IL-2, and thymic stromal lymphopoietin (TSLP) were analyzed by flow cytometry in CD4(+) T cells from 15 ICL patients and 15 healthy blood donors. The induction of phospho-STAT5 after IL-7 stimulation was decreased in memory CD4(+) T cells of some ICL patients, which correlated with a decreased expression of the IL-7Rα receptor chain (R = 0.74, p<0.005) and with lower CD4(+) T cell counts (R = 0.69, p<0.005). IL-2 responses were also impaired, both in the Treg and conventional memory subsets. Decreased IL-2 responses correlated with decreased IL-7 responses (R = 0.75, p<0.005), pointing to combined defects that may significantly perturb CD4(+) T cell homeostasis in a subset of ICL patients. Unexpectedly, responses to the IL-7-related cytokine TSLP were increased in ICL patients, while they remained barely detectable in healthy controls. TSLP responses correlated inversely with IL-7 responses (R = -0.41; p<0.05), suggesting a cross-regulation between the two cytokine systems. In conclusion, IL-7 and IL-2 signaling are impaired in ICL, which may account for the loss of CD4(+) T cell homeostasis. Increased TSLP responses point to a compensatory homeostatic mechanism that may mitigate defects in γc cytokine responses.
    Full-text · Article · Jan 2013 · PLoS ONE
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    • "This includes an increase in anti-inflammatory cytokines and a decrease in TNF-α in LPS stimulated spleen cells [60], reductions in interferon-γ and IL-2 following PMA and ionomycin stimulation of peripheral blood cells of astronauts [15], and reduced NK cell number and functionality [13], [14]. These alterations to immune function are very similar to those observed in settings of increased immune activation caused by exposure to pathogen associated molecular patterns (PAMPs), such as LPS [61], [62], [63], [64], [65], [66]. Specific examples include; a reduction in proinflammatory cytokine production by myeloid cells [66], [67], a reduction in antigen-specific T cell effector cytokine responses [61], and a reduction in circulating NK cells [68]. "
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    ABSTRACT: THE ENVIRONMENTAL CONDITIONS THAT COULD LEAD TO AN INCREASED RISK FOR THE DEVELOPMENT OF AN INFECTION DURING PROLONGED SPACE FLIGHT INCLUDE: microgravity, stress, radiation, disturbance of circadian rhythms, and altered nutritional intake. A large body of literature exists on the impairment of the immune system by space flight. With the advent of missions outside the Earth's magnetic field, the increased risk of adverse effects due to exposure to radiation from a solar particle event (SPE) needs to be considered. Using models of reduced gravity and SPE radiation, we identify that either 2 Gy of radiation or hindlimb suspension alone leads to activation of the innate immune system and the two together are synergistic. The mechanism for the transient systemic immune activation is a reduced ability of the GI tract to contain bacterial products. The identification of mechanisms responsible for immune dysfunction during extended space missions will allow the development of specific countermeasures.
    Full-text · Article · Sep 2012 · PLoS ONE
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