Implementation of an ex-vivo Th17 Assay
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1 Implementation of an ex-vivo Th17 Assay Dr Laine Hosking Immunology Laboratory, RCH
2 Background Expanding roles for CD4 + T cells in immunity to viruses Susan L. Swain, K. Kai McKinstry & Tara M. Strutt Nature Reviews Immunology 12, (February 2012) doi: /nri3152
3 T-Helper Type 17 Cells (Th17) Known to play a key role in mucosal immunity Differentiation is promoted mainly by dendritic cells secreting IL-1, IL-6 and TGF-β activate transcription factors STAT3 and RORγt IL-17 production IL-17 Induction of proinflammatory cytokines & chemokines Recruitment of neutrophils Distinguished from other CD4 T cells by receptors and IL-17 production
4 However
5 Chronic Mucocutaneous Candidiasis Heterogeneous group of disorders characterised by recurrent/persistent superficial infections of the skin, mucous membranes & nails with Candida organisms Susceptibility has been shown in patients with impaired Th17 development and function PIDs associated with CMC Decreased Th17 production STAT 3 LOF STAT 1 GOF IL12 and IL12RB1 deficiencies Autoantibodies against IL-17 AIRE mutations
6 AIRE mutations Curr Opin Allergy Clin Immunol Dec; 12(6):
7 Aim To implement a whole blood one-tube flow cytometric assay for the rapid identification of Th17 deficient patients; to identify patients with possible PID as cause of CMC and patients with suspected AD-HIES Modified protocol by Dhalla et al. (Clin. Exp. Immunol. 2016) who compared an in-vitro assay for Th17 cells using intracellular cytokine staining for IL-17A with an ex-vivo assay using cell surface markers CCR6+CXCR3 CCR4+CD161+
8 Method Th17 cells defined by their surface markers: CD45+CD3+CD4+CD45RA-CCR6+CXCR3- Cell surface markers CD45 KrO CD3 PCB CD4 FITC CD45RA PC7 CCR6 AF647 CXCR3 PE 100ul whole blood 30 minutes assay Acquired on Gallios Flow Cytometer Collect 20,000 CD4 T cell events Run in parallel to healthy control Results expressed as Th17 as percentage of CD4 T cells
9 Results 19 individual healthy controls have been assessed Th17 cells account for % of CD4+ T cells (5 th -95 th centile), mean 7.8% % of CD4+CD45RA- T cells (5 th -95 th centile) 3 molecularly defined PID patients 2 STAT 1 GOF 1 STAT 3 LOF
10 Healthy Control CD4 T Cells
11 STAT 3 Loss of Function 19yo male with Hyper-IgE syndrome (STAT3 LOF) Chronic Aspergillus infection with pneumatocoeles No CMC Th17 0.3% of CD4 T cells, and 1.9% of CD4+CD45RA- T cells
12 STAT 1 Gain of Function CC 42yo male with STAT1 GOF Th17 0.7% CD4 T cells, 1.34% of CD4+CD45RA- T cells Note if only assessing for CCR6+ cells this patient would look normal
13 STAT 1 GOF 5yo female with STAT 1 GOF CMC & bronchiectasis Th17 0.0% of CD4 T cells and 0.1% of CD4+CD45RA- T cells Quite a difference compared with adult STAT 1 patient for CCR6+ population
14 Clinical Utility All CMC patients run to date have lower Th17 as compared to healthy controls Cost effective & rapid flow assay that can be used as a screening tool in patients with chronic mucocutaneous candidiasis or AD-HIES Whole blood Set up within 24hrs Alternative method involves stimulation and intracellular staining Help target genetic testing where indicated
15 Challenges Determining what is normal for the paediatric population Lower memory CD4 T cells, therefore with reduced Th17 cells (as % of CD4)
16 References Dhalla F, Fox H, Davenport EE, et al. Chronic mucocutaneous candidiasis: characterization of a family with STAT 1 gain of function and development of an ex vivo assay for Th17 deficiency of diagnostic utility. Clinical and Experimental Immunology. 2016;184(2): doi: /cei Engelhardt KR, Grimbacher B. Mendelian traits causing susceptibility to mucocutaneous fungal infections in human subjects. J Allergy Clin Immunol 2012; 129: ; quiz 6 7 Iwakura Y, Ishigame H, Saijo S, Nakae S. Functional specialization of interleukin-17 family members. Immunity Feb 25;34(2): Puel A, Cypowyj S, Maródi L, Abel L, Picard C, Casanova J-L. Inborn errors of human IL-17 immunity underlie chronic mucocutaneous candidiasis. Current opinion in allergy and clinical immunology. 2012;12(6): doi: /aci.0b013e328358cc0b. Susan L. Swain, K. Kai McKinstry & Tara M. Strutt. Expanding roles for CD4+ T cells in immunity to viruses. Nature Reviews Immunology 12, (February 2012) doi: /nri3152
17 Thank You & Questions
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