EXTENDED REPORT

T cell subsets in patients with arthritis and chronic neutropenia

I Bank¹, L Cohen², M Mouallem³, Z Farfel³, E Grossman⁴, A Ben-Nun²

¹ Department of Medicine F and Laboratory for Immunoregulation, Chaim Sheba Medical Centre, Sackler School of Medicine, Tel Hashomer, Israel
² Department of Cell Biology, Weizmann Institute of Science, Rehovot, Israel
³ Department of Medicine E, Chaim Sheba Medical Centre
⁴ Department of Medicine D, Chaim Sheba Medical Centre

Correspondence to:
Correspondence to:
Dr I Bank, Department of Medicine F, Chaim Sheba Medical Centre, Tel Hashomer 52621, Israel;
ibank{at}post.tau.ac.il

Background: An abnormal distribution of subsets of T cells, which are a component of the inflammatory infiltrate in arthritic synovium, has been demonstrated in the peripheral blood (PB) of patients with arthritis and neutropenia.

Objective: To evaluate whether the clinical manifestations of patients with arthritis and neutropenia are related to the specific T cell subset predominant in the PB.

Methods: Flow cytometry of PB lymphocytes in six consecutive patients with chronic neutropenia and arthritis was performed. Variable (V) and gene families were analysed by polymerase chain reaction. cDNA was subjected to direct automated sequencing of T cell receptor (TCR) genes.

Results: Three patients had non-deforming and non-erosive rheumatoid factor (RF)⁺ polyarticular rheumatoid arthritis, RF⁺ oligoarticular arthritis, or RF^- non-deforming oligoarticular psoriatic arthritis with persistent expansions of V1⁺/V2⁺, V2⁺/V2⁺, or V1⁺/V ^{undetermined (2- 1-)} T cells, respectively. The other three patients, without persistent expansion of T cells, had either non-deforming and non-erosive oligo- or polyarthritis with a balanced distribution of several V and V genes, or severe erosive RF⁺ arthritis with deficiency of all but V1⁺/V1⁺ T cells.

Conclusions: T cell lymphoproliferations in chronic neutropenia and arthritis use different V and V gene families, often forming T cell receptor (TCR) structures that are infrequent in normal adult PB. Arthritis with V1⁺/V2⁺, V2⁺/V2⁺, or V1⁺/V2^-/V1^- T cells in the PB is non-deforming and non-erosive, suggesting a protective effect of these cells, as opposed to a more pathogenic contribution of V1⁺/V1⁺ cells.

Keywords: gamma delta T cells; neutropenia; autoimmunity; Felty's syndrome

Abbreviations: FS, Felty's syndrome; mAb, monoclonal antibody; PB, peripheral blood; PBL, peripheral blood lymphocytes; PBS, phosphate buffered saline; PCR, polymerase chain reaction; PFS, pseudo-Felty's syndrome; RA, rheumatoid arthritis; RF, rheumatoid factor; TCR, T cell receptor; T-LGLD, large granular T lymphocytic disorder

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