Convergence of cytokine dysregulation and antibody deficiency in common variable immunodeficiency with inflammatory complications - 05/01/22
Abstract |
Background |
Noninfectious complications are the greatest cause of morbidity and mortality in common variable immunodeficiency (CVID), but their pathogenesis remains poorly defined.
Objective |
Using high-throughput approaches, we aimed to identify, correlate, and determine the significance of immunologic features of CVID with noninfectious complications (CVIDc).
Methods |
We simultaneously applied proteomics, RNA sequencing, and mass cytometry to a large cohort with primary antibody deficiency.
Results |
CVIDc is differentiated from uncomplicated CVID, other forms of primary antibody deficiency, and healthy controls by a distinct plasma proteomic profile. In addition to confirming previously reported elevations of 4-1BB, IL-6, IL-18, and IFN-γ, we found elevations of colony-stimulating factor 1, IL-12p40, IL-18R, oncostatin M, TNF, and vascular endothelial growth factor A to differentiate CVIDc. This cytokine dysregulation correlated with deficiency of LPS-specific antibodies and increased soluble CD14, suggesting microbial translocation. Indicating potential significance of reduced LPS-specific antibodies and resultant microbial-induced inflammation, CVIDc had altered LPS-induced gene expression matching plasma proteomics and corresponding with increased CD14+CD16− monocytes, memory T cells, and tissue inflammation ameliorated by T-cell–targeted therapy. Unsupervised machine learning accurately differentiated subjects with CVIDc and supported cytokine dysregulation, antibody deficit, and T-cell activation as defining and convergent features.
Conclusions |
Our data expand understanding of CVIDc proteomics, establish its link with deficiency of IgA and LPS-specific antibodies, and implicate altered LPS-induced gene expression and elevated monocytes and T cells in this cytokine dysregulation. This work indicates that CVIDc results when insufficient antibody neutralization of pathogen-associated molecular patterns, like LPS, occurs in those with a heightened response to these inflammatory mediators, suggesting a 2-hit model of pathogenesis requiring further exploration.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Key words : Common variable immunodeficiency, CVID, lipopolysaccharide, LPS, noninfectious complications, IL-12, IFN-γ, TNF, monocytes, T cells
Abbreviations used : CVID, CVIDc, HC, MFA, PAD, PAMP, sCD14, TCM
Plan
| This work was funded by the National Institutes of Health (grant nos. AI137183 and AI151486), an AAAAI Foundation Faculty Development Award, investigator-initiated grants from Horizon Pharma and Takeda, and a Career Investment Award from Boston University (all to P.J.M.). The funding sources were not involved in the collection, analysis, interpretation of data, preparation of the manuscript, or the decision to submit this report for publication. |
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| Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest. |
Vol 149 - N° 1
P. 315 - janvier 2022 Retour au numéro
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