Elevated monocyte HLA-DR in pediatric secondary hemophagocytic lymphohistiocytosis: a retrospective study

IntroductionHemophagocytic lymphohistiocytosis (HLH) is a life-threatening condition, and its diagnosis may be challenging. In particular, some cases show close similarities to sepsis (fever, organ failure, and high ferritin), but their treatment, while urgent, differ: prompt broad-spectrum antibiotherapy for sepsis and immunosuppressive treatment for HLH. We questioned whether monocyte human leucocyte antigen (mHLA)–DR could be a diagnostic marker for secondary HLH (sHLH).MethodsWe retrospectively reviewed data from patients with a sHLH diagnosis and mHLA-DR quantification. mHLA-DR data from healthy children and children with septic shock, whose HLA-DR expression is reduced, from a previously published study were also included for comparison.ResultsSix patients with sHLH had mHLA-DR quantification. The median level of monocyte mHLA-DR expression in patients with sHLH [79,409 antibodies bound per cell (AB/C), interquartile range (IQR) (75,734–86,453)] was significantly higher than that in healthy children and those with septic shock (29,668 AB/C, IQR (24,335–39,199), and 7,493 AB/C, IQR (3,758–14,659), respectively). Each patient with sHLH had a mHLA-DR higher than our laboratory normal values. Four patients had a second mHLA-DR sampling 2 to 4 days after the initial analysis and treatment initiation with high-dose corticosteroids; for all patients, mHLA-DR decreased to within or close to the normal range. One patient with systemic juvenile idiopathic arthritis had repeated mHLA-DR measurements over a 200-day period during which she underwent four HLH episodes. mHLA-DR increased during relapses and normalized after treatment incrementation.ConclusionIn this small series, mHLA-DR was systematically elevated in patients with sHLH. Elevated mHLA-DR could contribute to sHLH diagnosis and help earlier distinction with septic shock

Sepsis in PD-1 light

Increasing evidence suggests that after the first pro-inflammatory hours, sepsis is characterized by the occurrence of severe immunosuppression. Several mechanisms have been reported to participate in sepsis-induced immune alterations affecting both innate and adaptive immunity. Of these, the concept of ‘cell exhaustion’ has gained a lot of interest because some parallels can be drawn with the cancer field in which immunostimulation approaches through blocking immune checkpoints currently obtain remarkable success. Herein, perspectives regarding co-inhibitory receptors’ contribution to lymphocyte exhaustion in sepsis will be discussed in the context of a recently published study investigating the potential of PD-1 molecule expression (i.e. PD-1 on lymphocytes, PD-L1 on monocytes) to predict mortality in septic shock patients

CD32-Expressing CD4 T Cells Are Phenotypically Diverse and Can Contain Proviral HIV DNA.

Efforts to both characterize and eradicate the HIV reservoir have been limited by the rarity of latently infected cells and the absence of a specific denoting biomarker. CD32a (FcγRIIa) has been proposed to be a marker for an enriched CD4 T cell HIV reservoir, but this finding remains controversial. Here, we explore the expression of CD32 on CD3+CD4+ cells in participants from two primary HIV infection studies and identify at least three distinct phenotypes (CD32low, CD32+CD14+, and CD32high). Of note, CD4 negative enrichment kits remove the majority of CD4+CD32+ T cells, potentially skewing subsequent analyses if used. CD32high CD4 T cells had higher levels of HLA-DR and HIV co-receptor expression than other subsets, compatible with their being more susceptible to infection. Surprisingly, they also expressed high levels of CD20, TCRαβ, IgD, and IgM (but not IgG), markers for both T cells and naïve B cells. Compared with other populations, CD32low cells had a more differentiated memory phenotype and high levels of immune checkpoint receptors, programmed death receptor-1 (PD-1), Tim-3, and TIGIT. Within all three CD3+CD4+CD32+ phenotypes, cells could be identified in infected participants, which contained HIV DNA. CD32 expression on CD4 T cells did not correlate with HIV DNA or cell-associated HIV RNA (both surrogate measures of overall reservoir size) or predict time to rebound viremia following treatment interruption, suggesting that it is not a dominant biomarker for HIV persistence. Our data suggest that while CD32+ T cells can be infected with HIV, CD32 is not a specific marker of the reservoir although it might identify a population of HIV enriched cells in certain situations

CD32-Expressing CD4 T Cells Are Phenotypically Diverse and Can Contain Proviral HIV DNA.

Efforts to both characterize and eradicate the HIV reservoir have been limited by the rarity of latently infected cells and the absence of a specific denoting biomarker. CD32a (FcγRIIa) has been proposed to be a marker for an enriched CD4 T cell HIV reservoir, but this finding remains controversial. Here, we explore the expression of CD32 on CD3+CD4+ cells in participants from two primary HIV infection studies and identify at least three distinct phenotypes (CD32low, CD32+CD14+, and CD32high). Of note, CD4 negative enrichment kits remove the majority of CD4+CD32+ T cells, potentially skewing subsequent analyses if used. CD32high CD4 T cells had higher levels of HLA-DR and HIV co-receptor expression than other subsets, compatible with their being more susceptible to infection. Surprisingly, they also expressed high levels of CD20, TCRαβ, IgD, and IgM (but not IgG), markers for both T cells and naïve B cells. Compared with other populations, CD32low cells had a more differentiated memory phenotype and high levels of immune checkpoint receptors, programmed death receptor-1 (PD-1), Tim-3, and TIGIT. Within all three CD3+CD4+CD32+ phenotypes, cells could be identified in infected participants, which contained HIV DNA. CD32 expression on CD4 T cells did not correlate with HIV DNA or cell-associated HIV RNA (both surrogate measures of overall reservoir size) or predict time to rebound viremia following treatment interruption, suggesting that it is not a dominant biomarker for HIV persistence. Our data suggest that while CD32+ T cells can be infected with HIV, CD32 is not a specific marker of the reservoir although it might identify a population of HIV enriched cells in certain situations

Rôle des cellules B régulatrices dans l’immunodépression induite par le choc septique

Sepsis in a major health problem associated with rising incidence and high mortality rate. In septic patients, an initial proinflammatory response causing life-threatening organ failures is followed by the development of a deep immunosuppression, associated with increased risk of secondary infections and death. In this context, immunostimulating therapies are currently tested. However, success of this strategy requires identification of relevant therapeutical targets and biomarkers allowing individualisation of treatments. B lymphocytes have been poorly studied in sepsis. Moreover, existence of regulatory B cells was recently revealed in several clinical contexts. Thus, we made the assumption that regulatory B lymphocytes or plasma cells could be implied in sepsis-induced immunosuppression establishment.In septic shock patients, we showed that B cells present with decreased proliferation capacity and exhausted-like profile, and are able to produce immunosuppressive IL-10 (Journal of Immunology 2018). We also observed blood plasmacytosis in patients, confirmed by mass cytometry analysis (Scientific Reports 2018). In a murine model of sepsis, the ability of plasma cells to inhibit T cell proliferation ex vivo, and their phenotypic profile suggest for the first time the existence of regulatory plasma cells in sepsis.The role of regulatory plasma cells within sepsis-induced immunosuppression has to be further explored in patients (underlying regulatory mechanisms, associations with clinical outcomes and viral reactivations…). It could highlight novel biomarkers for patients’ monitoring and innovative therapeutical approachesLe sepsis est un problème mondial de santé publique du fait de son incidence croissante et de sa mortalité importante. Après une première phase très inflammatoire, les patients septiques présentent une profonde immunodépression, objectivée par un risque accru d’infections secondaires et de décès. Dans ce contexte, des thérapeutiques immunostimulantes sont actuellement testées. Afin d’identifier des cibles thérapeutiques pertinentes et des biomarqueurs permettant l’individualisation des traitements, la description exhaustive des mécanismes immunosuppresseurs mis en jeu est primordiale. Les lymphocytes B ont été peu étudiés au cours du sepsis. Des données récentes ont révélé l’existence de cellules B régulatrices dans différents contextes cliniques. Ainsi, nous avons fait l’hypothèse que des lymphocytes B / plasmocytes régulateurs pouvaient être impliqués dans l’établissement de l’immunodépression induite par le sepsis.Chez les patients en choc septique, nous avons montré que les lymphocytes B présentent une perte de leur fonction de prolifération et un phénotype d’épuisement cellulaire. Ils produisent de l’IL-10, cytokine suppressive (Journal of Immunology 2018). Enfin, une plasmocytose circulante apparait, confirmée par cytométrie de masse (Scientific Reports 2018). Dans un modèle murin de sepsis, ces plasmocytes inhibent la prolifération des lymphocytes T ex vivo et expriment des marqueurs phénotypiques suggérant pour la première fois la présence de plasmocytes régulateurs dans le sepsis.L’importance clinique des plasmocytes régulateurs reste à définir (mécanismes régulateurs, liens avec les paramètres cliniques, association avec les réactivations virales…). Elle pourrait conduire à l’établissement de nouveaux biomarqueurs pour le suivi immunitaire des patients et à de nouvelles approches thérapeutique

Role of regulatory B cells in sepsis-induced immunosuppression

Le sepsis est un problème mondial de santé publique du fait de son incidence croissante et de sa mortalité importante. Après une première phase très inflammatoire, les patients septiques présentent une profonde immunodépression, objectivée par un risque accru d’infections secondaires et de décès. Dans ce contexte, des thérapeutiques immunostimulantes sont actuellement testées. Afin d’identifier des cibles thérapeutiques pertinentes et des biomarqueurs permettant l’individualisation des traitements, la description exhaustive des mécanismes immunosuppresseurs mis en jeu est primordiale. Les lymphocytes B ont été peu étudiés au cours du sepsis. Des données récentes ont révélé l’existence de cellules B régulatrices dans différents contextes cliniques. Ainsi, nous avons fait l’hypothèse que des lymphocytes B / plasmocytes régulateurs pouvaient être impliqués dans l’établissement de l’immunodépression induite par le sepsis.Chez les patients en choc septique, nous avons montré que les lymphocytes B présentent une perte de leur fonction de prolifération et un phénotype d’épuisement cellulaire. Ils produisent de l’IL-10, cytokine suppressive (Journal of Immunology 2018). Enfin, une plasmocytose circulante apparait, confirmée par cytométrie de masse (Scientific Reports 2018). Dans un modèle murin de sepsis, ces plasmocytes inhibent la prolifération des lymphocytes T ex vivo et expriment des marqueurs phénotypiques suggérant pour la première fois la présence de plasmocytes régulateurs dans le sepsis.L’importance clinique des plasmocytes régulateurs reste à définir (mécanismes régulateurs, liens avec les paramètres cliniques, association avec les réactivations virales…). Elle pourrait conduire à l’établissement de nouveaux biomarqueurs pour le suivi immunitaire des patients et à de nouvelles approches thérapeutiquesSepsis in a major health problem associated with rising incidence and high mortality rate. In septic patients, an initial proinflammatory response causing life-threatening organ failures is followed by the development of a deep immunosuppression, associated with increased risk of secondary infections and death. In this context, immunostimulating therapies are currently tested. However, success of this strategy requires identification of relevant therapeutical targets and biomarkers allowing individualisation of treatments. B lymphocytes have been poorly studied in sepsis. Moreover, existence of regulatory B cells was recently revealed in several clinical contexts. Thus, we made the assumption that regulatory B lymphocytes or plasma cells could be implied in sepsis-induced immunosuppression establishment.In septic shock patients, we showed that B cells present with decreased proliferation capacity and exhausted-like profile, and are able to produce immunosuppressive IL-10 (Journal of Immunology 2018). We also observed blood plasmacytosis in patients, confirmed by mass cytometry analysis (Scientific Reports 2018). In a murine model of sepsis, the ability of plasma cells to inhibit T cell proliferation ex vivo, and their phenotypic profile suggest for the first time the existence of regulatory plasma cells in sepsis.The role of regulatory plasma cells within sepsis-induced immunosuppression has to be further explored in patients (underlying regulatory mechanisms, associations with clinical outcomes and viral reactivations…). It could highlight novel biomarkers for patients’ monitoring and innovative therapeutical approache

Sepsis in PD-1 light

International audienceIncreasing evidence suggests that after the first pro-inflammatory hours, sepsis is characterized by the occurrence of severe immunosuppression. Several mechanisms have been reported to participate in sepsis-induced immune alterations affecting both innate and adaptive immunity. Of these, the concept of 'cell exhaustion' has gained a lot of interest because some parallels can be drawn with the cancer field in which immunostimulation approaches through blocking immune checkpoints currently obtain remarkable success. Herein, perspectives regarding co-inhibitory receptors' contribution to lymphocyte exhaustion in sepsis will be discussed in the context of a recently published study investigating the potential of PD-1 molecule expression (i.e. PD-1 on lymphocytes, PD-L1 on monocytes) to predict mortality in septic shock patient

Monocyte HLA‐DR Measurement by Flow Cytometry in COVID ‐19 Patients: An Interim Review

International audienceSeveral months after the sudden emergence of SARS-CoV-2 and COVID-19, the understanding of the appropriate host immune response to a virus totally unknown ofhuman immune surveillance is still of major importance. By international definition,COVID-19 falls in the scope of septic syndromes (organ dysfunction due to dysregulatedhost response to an infection) in which immunosuppression is a significant driver of mortality. Sepsis-induced immunosuppression is mostly defined and monitored by the measurement of decreased expression of HLA-DR molecules on circulating monocytes (mHLA-DR). In this interim review, we summarize the first mHLA-DR results in COVID-19 patients. In critically ill patients, results homogenously indicate a decreased mHLA-DR expression, which, along with profound lymphopenia and other functional alterations, is indicative of a status of immunosuppression

Automated bedside flow cytometer for mHLA-DR expression measurement: a comparison study with reference protocol

Abstract Background In various ICU conditions, measurement of diminished expression of human leukocyte antigen-DR on circulating monocytes (mHLA-DR) by flow cytometry appears to be a reliable marker of acquired immunosuppression. Low mHLA-DR is associated with an increased risk of nosocomial infections and mortality. Nevertheless, its use remains somewhat limited and has not been adopted in common medical practice. The main drawback of mHLA-DR measurement is likely related to the use of flow cytometry that is not accessible everywhere on a 24/7 basis. Recently, the Accellix system, a fully automated table top cytometer, was developed for use at bedside or emergency labs. Methods The objective was to assess the performance of the Accellix (beta site evaluation including repeatability and method comparison with reference protocol) for the measurement of mHLA-DR expression. Results Accellix repeatability at low and high expression levels of mHLA-DR was < 10% (i.e., within the range of acceptability for clinical flow cytometry). In comparison study including 139 blood samples (67 septic shock patients and 17 healthy volunteers), Pearson’s correlation parameters (r 2) ranged from 0.71 to 0.97 (p < 0.001). Intra-class correlation coefficient was 0.92. Conclusions This fully automated table top cytometer appears to be a suitable tool for ICU patient monitoring and on-going clinical trials as there is no sample preparation and no need for specific skills in flow cytometry. Upon validation in a larger cohort study to reinforce reliability, Accellix could represent a major step to make flow cytometry accessible to clinicians by placing the instrument inside intensive care units or emergency laboratories