Background: IgG(4)-related disease (IgG(4)-RD) is an immune-mediated fibrotic disorder that has been linked to CD4(+) cytotoxic T lymphocytes (CD4(+)CTLs). The effector phenotype of CD4(+)CTLs and... Show moreBackground: IgG(4)-related disease (IgG(4)-RD) is an immune-mediated fibrotic disorder that has been linked to CD4(+) cytotoxic T lymphocytes (CD4(+)CTLs). The effector phenotype of CD4(+)CTLs and the relevance of both CD8(+) cytotoxic T lymphocytes (CD8(+)CTLs) and apoptotic cell death remain undefined in IgG(4)-RD.Objective: We sought to define CD4(+)CTL heterogeneity, characterize the CD8(+)CTL response in the blood and in lesions, and determine whether enhanced apoptosis may contribute to the pathogenesis of IgG(4)-RD.Methods: Blood analyses were undertaken using flow cytometry, cell sorting, transcriptomic analyses at the population and single-cell levels, and next-generation sequencing for the TCR repertoire. Tissues were interrogated using multicolor immunofluorescence. Results were correlated with clinical data.Results: We establish that among circulating CD4(+)CTLs in IgG(4)-RD, CD27(lo)CD28(lo)CD57(hi) cells are the dominant effector subset, exhibit marked clonal expansion, and differentially express genes relevant to cytotoxicity, activation, and enhanced metabolism. We also observed prominent infiltration of granzyme A-expressing CD8(+)CTLs in disease tissues and clonal expansion in the blood of effector/memory CD8(+) T cells with an activated and cytotoxic phenotype. Tissue studies revealed an abundance of cells undergoing apoptotic cell death disproportionately involving nonimmune, nonendothelial cells of mesenchymal origin. Apoptotic cells showed significant upregulation of HLA-DR.Conclusions: CD4(+)CTLs and CD8(+)CTLs may induce apoptotic cell death in tissues of patients with IgG(4)-RD with preferential targeting of nonendothelial, nonimmune cells of mesenchymal origin. Show less
Systemic sclerosis (SSc) is an autoimmune fibrotic disease whose pathogenesis is poorly understood and lacks effective therapies. We undertook quantitative analyses of T cell infiltrates in the... Show moreSystemic sclerosis (SSc) is an autoimmune fibrotic disease whose pathogenesis is poorly understood and lacks effective therapies. We undertook quantitative analyses of T cell infiltrates in the skin of 35 untreated patients with early diffuse SSc and here show that CD4(+) cytotoxic T cells and CD8(+) T cells contribute prominently to these infiltrates. We also observed an accumulation of apoptotic cells in SSc tissues, suggesting that recurring cell death may contribute to tissue damage and remodeling in this fibrotic disease. HLA-DR-expressing endothelial cells were frequent targets of apoptosis in SSc, consistent with the prominent vasculopathy seen in patients with this disease. A circulating effector population of cytotoxic CD4(+) T cells, which exhibited signatures of enhanced metabolic activity, was clonally expanded in patients with systemic sclerosis. These data suggest that cytotoxic T cells may induce the apoptotic death of endothelial and other cells in systemic sclerosis. Cell loss driven by immune cells may be followed by overly exuberant tissue repair processes that lead to fibrosis and tissue dysfunction. Show less
