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Bremer SJ, Boxnick A, Glau L, Biermann D, Joosse SA, Thiele F, Billeb E, May J, Kolster M, Hackbusch R, Fortmann MI, Kozlik-Feldmann R, Hübler M, Tolosa E, Sachweh JS, Gieras A. Thymic Atrophy and Immune Dysregulation in Infants with Complex Congenital Heart Disease. J Clin Immunol 2024; 44:69. [PMID: 38393459 PMCID: PMC10891212 DOI: 10.1007/s10875-024-01662-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/24/2024] [Indexed: 02/25/2024]
Abstract
Congenital heart disease (CHD) is the most common birth defect, and up to 50% of infants with CHD require cardiovascular surgery early in life. Current clinical practice often involves thymus resection during cardiac surgery, detrimentally affecting T-cell immunity. However, epidemiological data indicate that CHD patients face an elevated risk for infections and immune-mediated diseases, independent of thymectomy. Hence, we examined whether the cardiac defect impacts thymus function in individuals with CHD. We investigated thymocyte development in 58 infants categorized by CHD complexity. To assess the relationship between CHD complexity and thymic function, we analyzed T-cell development, thymic output, and biomarkers linked to cardiac defects, stress, or inflammation. Patients with highly complex CHD exhibit thymic atrophy, resulting in low frequencies of recent thymic emigrants in peripheral blood, even prior to thymectomy. Elevated plasma cortisol levels were detected in all CHD patients, while high NT-proBNP and IL-6 levels were associated with thymic atrophy. Our findings reveal an association between complex CHD and thymic atrophy, resulting in reduced thymic output. Consequently, thymus preservation during cardiovascular surgery could significantly enhance immune function and the long-term health of CHD patients.
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Affiliation(s)
- Sarah-Jolan Bremer
- Department of Immunology, University Medical Center Hamburg-Eppendorf, N27, Martinistraße 52, 20246, Hamburg, Germany
- University Children's Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Annika Boxnick
- Department of Immunology, University Medical Center Hamburg-Eppendorf, N27, Martinistraße 52, 20246, Hamburg, Germany
| | - Laura Glau
- Department of Immunology, University Medical Center Hamburg-Eppendorf, N27, Martinistraße 52, 20246, Hamburg, Germany
| | - Daniel Biermann
- Congenital and Pediatric Heart Surgery, Children's Heart Clinic, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Simon A Joosse
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Mildred Scheel Cancer Career Center HaTriCS4, University, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Friederike Thiele
- Department of Immunology, University Medical Center Hamburg-Eppendorf, N27, Martinistraße 52, 20246, Hamburg, Germany
| | - Elena Billeb
- Department of Immunology, University Medical Center Hamburg-Eppendorf, N27, Martinistraße 52, 20246, Hamburg, Germany
- University Children's Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jonathan May
- Department of Immunology, University Medical Center Hamburg-Eppendorf, N27, Martinistraße 52, 20246, Hamburg, Germany
| | - Manuela Kolster
- Department of Immunology, University Medical Center Hamburg-Eppendorf, N27, Martinistraße 52, 20246, Hamburg, Germany
| | - Romy Hackbusch
- Department of Immunology, University Medical Center Hamburg-Eppendorf, N27, Martinistraße 52, 20246, Hamburg, Germany
| | | | - Rainer Kozlik-Feldmann
- Department of Pediatric Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Hübler
- Congenital and Pediatric Heart Surgery, Children's Heart Clinic, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Eva Tolosa
- Department of Immunology, University Medical Center Hamburg-Eppendorf, N27, Martinistraße 52, 20246, Hamburg, Germany
| | - Jörg Siegmar Sachweh
- Congenital and Pediatric Heart Surgery, Children's Heart Clinic, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Anna Gieras
- Department of Immunology, University Medical Center Hamburg-Eppendorf, N27, Martinistraße 52, 20246, Hamburg, Germany.
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Rosenkranz SC, Häußler V, Kolster M, Willing A, Matschke J, Röcken C, Stürner K, Leypoldt F, Tolosa E, Friese MA. Treating sarcoidosis-associated progressive multifocal leukoencephalopathy with infliximab. Brain Commun 2022; 4:fcab292. [PMID: 34993476 PMCID: PMC8727989 DOI: 10.1093/braincomms/fcab292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 10/12/2021] [Accepted: 11/09/2021] [Indexed: 11/27/2022] Open
Abstract
Although most of the progressive multifocal leukoencephalopathy cases in sarcoidosis patients are explained by the treatment with immunosuppressive drugs, it is also reported in treatment-naive sarcoidosis patients, which implies a general predisposition of sarcoidosis patients for progressive multifocal leukoencephalopathy. Indeed, it was shown that active sarcoidosis patients have increased regulatory T cell frequencies which could lead to a subsequent systemic immunosuppression. However, if sarcoidosis with systemic changes of T cell subsets frequencies constitute a risk factor for the development of progressive multifocal leukoencephalopathy, which could then be counteracted by sarcoidosis treatment, is not known. In this cohort study, we included, characterized and followed-up six patients with bioptically confirmed definite progressive multifocal leukoencephalopathy and definite or probable sarcoidosis presenting between April 2013 and January 2019, four of them had no immunosuppressive therapy at the time of developing first progressive multifocal leukoencephalopathy symptoms. Analysis of immune cell subsets in these patients revealed significant imbalances of CD4+ T cell and regulatory T cell frequencies. Due to the progression of progressive multifocal leukoencephalopathy in four patients, we decided to treat sarcoidosis anticipating normalization of immune cell subset frequencies and thereby improving progressive multifocal leukoencephalopathy. Notably, by treatment with infliximab, an antibody directed against tumour necrosis factor-α, three patients continuously improved clinically, JC virus was no longer detectable in the cerebrospinal fluid and regulatory T cell frequencies decreased. One patient was initially misdiagnosed as neurosarcoidosis and died 9 weeks after treatment initiation due to aspiration pneumonia. Our study provides insight that sarcoidosis can lead to changes in T cell subset frequencies, which predisposes to progressive multifocal leukoencephalopathy. Although immunosuppressive drugs should be avoided in progressive multifocal leukoencephalopathy, paradoxically in patients with sarcoidosis treatment with the immunosuppressive infliximab might restore normal T cell distribution and thereby halt progressive multifocal leukoencephalopathy progression.
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Affiliation(s)
- Sina C Rosenkranz
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany
| | - Vivien Häußler
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany
| | - Manuela Kolster
- Department of Immunology, University Medical Center Hamburg-Eppendorf, Germany
| | - Anne Willing
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Germany
| | - Jakob Matschke
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Germany
| | - Christoph Röcken
- Institute of Pathology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Klarissa Stürner
- Neuroimmunology, Institute of Clinical Chemistry, University Medical Center Schleswig-Holstein, Kiel, Germany.,Department of Neurology, University Medical Center Schleswig-Holstein and Kiel University, Kiel, Germany
| | - Frank Leypoldt
- Neuroimmunology, Institute of Clinical Chemistry, University Medical Center Schleswig-Holstein, Kiel, Germany.,Department of Neurology, University Medical Center Schleswig-Holstein and Kiel University, Kiel, Germany
| | - Eva Tolosa
- Department of Immunology, University Medical Center Hamburg-Eppendorf, Germany
| | - Manuel A Friese
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Germany
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Thom V, Schmid S, Gelderblom M, Hackbusch R, Kolster M, Schuster S, Thomalla G, Keminer O, Pleß O, Bernreuther C, Glatzel M, Wegscheider K, Gerloff C, Magnus T, Tolosa E. IL-17 production by CSF lymphocytes as a biomarker for cerebral vasculitis. Neurol Neuroimmunol Neuroinflamm 2016; 3:e214. [PMID: 27144213 PMCID: PMC4841502 DOI: 10.1212/nxi.0000000000000214] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 01/13/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To explore the possibility of using interleukin-17 (IL-17) production by CD4+ T cells in the CSF as a potential biomarker for cerebral vasculitis in stroke patients. METHODS In this consecutive case study, we performed prospective analysis of CSF and blood in patients admitted to a university medical center with symptoms of stroke and suspected cerebral vasculitis. Flow cytometry was performed for intracellular detection of inflammatory cytokines in peripheral blood lymphocytes and expanded T cells from CSF. RESULTS CSF CD4+ lymphocytes from patients with cerebral vasculitis showed significantly higher levels of the proinflammatory cytokine IL-17 compared to patients with stroke not due to vasculitis or with other, noninflammatory neurologic diseases. There was no difference in the production of interferon-γ in the CSF and no overall differences in the relative frequencies of peripheral immune cells. CONCLUSIONS Intracellular IL-17 in CSF cells is potentially useful in discriminating cerebral vasculitis as a rare cause in patients presenting with ischemic stroke. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that an increased proportion of IL-17-producing CD4+ cells in CSF of patients presenting with stroke symptoms is indicative of cerebral vasculitis (sensitivity 73%, 95% confidence interval [CI] 39-94%; specificity 100%, 95% CI 74%-100%).
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Affiliation(s)
- Vivien Thom
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
| | - Sabrina Schmid
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
| | - Mathias Gelderblom
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
| | - Romy Hackbusch
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
| | - Manuela Kolster
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
| | - Simon Schuster
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
| | - Götz Thomalla
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
| | - Oliver Keminer
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
| | - Ole Pleß
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
| | - Christian Bernreuther
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
| | - Markus Glatzel
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
| | - Karl Wegscheider
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
| | - Christian Gerloff
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
| | - Tim Magnus
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
| | - Eva Tolosa
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
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