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McLean MR, Wragg KM, Lopez E, Kiazyk SA, Ball TB, Bueti J, Kent SJ, Juno JA, Chung AW. Serological and cellular inflammatory signatures in end-stage kidney disease and latent tuberculosis. Clin Transl Immunology 2021; 10:e1355. [PMID: 34765193 PMCID: PMC8569694 DOI: 10.1002/cti2.1355] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 05/21/2021] [Revised: 08/08/2021] [Accepted: 10/21/2021] [Indexed: 12/28/2022] Open
Abstract
Objectives Tuberculosis comorbidity with chronic diseases including diabetes, HIV and chronic kidney disease is of rising concern. In particular, latent tuberculosis infection (LTBI) comorbidity with end‐stage kidney disease (ESKD) is associated with up to 52.5‐fold increased risk of TB reactivation to active tuberculosis infection (ATBI). The immunological mechanisms driving this significant rise in TB reactivation are poorly understood. To contribute to this understanding, we performed a comprehensive assessment of soluble and cellular immune features amongst a unique cohort of patients comorbid with ESKD and LTBI. Methods We assessed the plasma and cellular immune profiles from patients with and without ESKD and/or LTBI (N = 40). We characterised antibody glycosylation, serum complement and cytokine levels. We also assessed classical and non‐classical monocytes and T cells with flow cytometry. Using a systems‐based approach, we identified key immunological features that discriminate between the different disease states. Results Individuals with ESKD exhibited a highly inflammatory plasma profile and an activated cellular state compared with those without ESKD, including higher levels of inflammatory antibody Fc glycosylation structures and activated CX3CR1+ monocytes that correlate with increased inflammatory plasma cytokines. Similar elevated inflammatory signatures were also observed in ESKD+/LTBI+ compared with ESKD−/LTBI+, suggesting that ESKD induces an overwhelming inflammatory immune state. In contrast, no significant inflammatory differences were observed when comparing LTBI+ and LTBI− individuals. Conclusion Our study highlights the highly inflammatory state induced by ESKD. We hypothesise that this inflammatory state could contribute to the increased risk of TB reactivation in ESKD patients.
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Affiliation(s)
- Milla R McLean
- Department of Microbiology and Immunology University of Melbourne at The Peter Doherty Institute for Infection and Immunity Melbourne VIC Australia
| | - Kathleen M Wragg
- Department of Microbiology and Immunology University of Melbourne at The Peter Doherty Institute for Infection and Immunity Melbourne VIC Australia
| | - Ester Lopez
- Department of Microbiology and Immunology University of Melbourne at The Peter Doherty Institute for Infection and Immunity Melbourne VIC Australia
| | - Sandra A Kiazyk
- National HIV and Retrovirology Laboratory National Microbiology Laboratory JC Wilt Infectious Diseases Research Centre Public Health Agency of Canada Winnipeg MB Canada.,Department of Medical Microbiology and Infectious Diseases University of Manitoba Winnipeg MB Canada
| | - Terry Blake Ball
- National HIV and Retrovirology Laboratory National Microbiology Laboratory JC Wilt Infectious Diseases Research Centre Public Health Agency of Canada Winnipeg MB Canada
| | - Joe Bueti
- Department of Internal Medicine University of Manitoba Winnipeg MB Canada.,Section of Nephrology Department of Internal Medicine University of Manitoba MB Canada.,Health Sciences Centre Winnipeg MB Canada
| | - Stephen J Kent
- Department of Microbiology and Immunology University of Melbourne at The Peter Doherty Institute for Infection and Immunity Melbourne VIC Australia.,Australian Research Council Centre for Excellence in Convergent Bio-Nano Science and Technology University of Melbourne Melbourne VIC Australia.,Melbourne Sexual Health Centre and Department of Infectious Diseases Alfred Hospital and Central Clinical School Monash University Melbourne VIC Australia
| | - Jennifer A Juno
- Department of Microbiology and Immunology University of Melbourne at The Peter Doherty Institute for Infection and Immunity Melbourne VIC Australia
| | - Amy W Chung
- Department of Microbiology and Immunology University of Melbourne at The Peter Doherty Institute for Infection and Immunity Melbourne VIC Australia
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Juno JA, Waruk JLM, Wragg KM, Mesa C, Lopez C, Bueti J, Kent SJ, Ball TB, Kiazyk SA. Mucosal-Associated Invariant T Cells Are Depleted and Exhibit Altered Chemokine Receptor Expression and Elevated Granulocyte Macrophage-Colony Stimulating Factor Production During End-Stage Renal Disease. Front Immunol 2018; 9:1076. [PMID: 29868028 PMCID: PMC5967229 DOI: 10.3389/fimmu.2018.01076] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 02/08/2018] [Accepted: 04/30/2018] [Indexed: 12/17/2022] Open
Abstract
Background End-stage renal disease (ESRD) is associated with an increased susceptibility to infectious diseases, including infection with Mycobacterium tuberculosis (Mtb). Mucosal-associated invariant T (MAIT) cells recognize vitamin B metabolites produced by many bacterial species, including Mtb, and may play an important role in providing protective immunity against tuberculosis infection in the lung. To date, little is known about MAIT cell frequency, phenotype, or function in ESRD patients. Methods MAIT cells, identified by surface marker expression or MR1 tetramer binding, were characterized in 20 ESRD and 20 healthy control participants by multicolor flow cytometry. Ex vivo MAIT cell phenotype and cytokine production following PMA/ionomycin, IL-12/IL-18, or Escherichia coli stimulation were determined. Monocyte phenotype and plasma C-reactive protein/inflammatory cytokine levels were quantified by flow cytometry, ELISA, and multiplex bead array. Results Peripheral blood MAIT cells were significantly depleted among ESRD patients compared to controls by both phenotypic and tetramer analysis and exhibited a loss of CXCR3 expression coupled to increased expression of CCR6 and CXCR6. ESRD was also associated with a shift in MAIT PMA-induced cytokine production away from IFNγ production and toward granulocyte macrophage-colony stimulating factor (GM-CSF) secretion, and a loss of E. coli-stimulated tumor necrosis factor α expression. Loss of IFNγ expression was associated with a combination of age, alterations in Tbet and Eomes expression, and inflammatory plasma cytokine levels. Conclusion The loss of peripheral blood MAIT cells and associated shifts in tissue homing receptor expression and GM-CSF production may contribute to an immune environment that is permissive to bacterial replication, particularly in the lungs.
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Affiliation(s)
- Jennifer A Juno
- Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada.,Department of Microbiology and Immunology, Peter Doherty Institute, University of Melbourne, Melbourne, VIC, Australia
| | - Jillian L M Waruk
- Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada
| | - Kathleen M Wragg
- Department of Microbiology and Immunology, Peter Doherty Institute, University of Melbourne, Melbourne, VIC, Australia
| | - Christine Mesa
- National Laboratory for HIV Immunology, HIV/TB Co-Infection Unit, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Carmen Lopez
- Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada
| | - Joe Bueti
- Renal Program, Health Sciences Centre, Winnipeg, MB, Canada
| | - Stephen J Kent
- Department of Microbiology and Immunology, Peter Doherty Institute, University of Melbourne, Melbourne, VIC, Australia.,Melbourne Sexual Health Centre, Department of Infectious Diseases, Alfred Health, Central Clinical School, Monash University, Melbourne, VIC, Australia.,ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, University of Melbourne, Parkville, VIC, Australia
| | - T Blake Ball
- Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada.,National Laboratory for HIV Immunology, HIV/TB Co-Infection Unit, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Sandra A Kiazyk
- Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada.,National Laboratory for HIV Immunology, HIV/TB Co-Infection Unit, Public Health Agency of Canada, Winnipeg, MB, Canada
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Juno JA, Waruk JLM, Harris A, Mesa C, Lopez C, Bueti J, Ball TB, Kiazyk SA. γδ T-cell function is inhibited in end-stage renal disease and impacted by latent tuberculosis infection. Kidney Int 2017; 92:1003-1014. [PMID: 28651949 DOI: 10.1016/j.kint.2017.03.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 03/06/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
Abstract
Patients with end-stage renal disease (ESRD) are at elevated risk of acquiring infectious diseases, including tuberculosis (TB). Inflammation and uremia negatively impact immune function in this population, but specific pathways involved in TB immunity have not been identified. Although γδ T cells are known to contribute to protection from TB, their phenotype and function in patients with ESRD is relatively unknown. To determine this we recruited 20 patients with and 20 without ESRD (controls), with or without latent TB infection to assess γδ T cell frequency, surface phenotype, and cytokine production by flow cytometry in response to stimulation. γδ T cells derived from patients with ESRD exhibited significantly lower expression of CCR5, CXCR3, and CD26 compared to controls. Furthermore, patients with ESRD, particularly the group with latent TB infection, exhibited poor IFNγ, TNFα, and GMCSF responses to stimulation with either phosphoantigen HMB-PP, IL-12/IL-18, E. coli, or phorbol myristate acetate and ionomycin. Similar dysfunctional responses were observed in patients with active TB. Surprisingly, neither the γδ phenotype nor its function was associated with plasma markers of inflammation or microbial translocation. Thus, there is significant perturbation of the γδ T-cell population in patients with ESRD, particularly in those with latent TB infection.
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Affiliation(s)
- Jennifer A Juno
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada; Department of Microbiology and Immunology, University of Melbourne, Melbourne, Australia.
| | - Jillian L M Waruk
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada
| | - Angela Harris
- National Laboratory for HIV Immunology, HIV/TB Co-Infection Unit, Public Health Agency of Canada, Winnipeg, Canada
| | - Christine Mesa
- National Laboratory for HIV Immunology, HIV/TB Co-Infection Unit, Public Health Agency of Canada, Winnipeg, Canada
| | - Carmen Lopez
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada
| | - Joe Bueti
- Renal Program, Health Sciences Centre, Winnipeg, Canada
| | - T Blake Ball
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada; National Laboratory for HIV Immunology, HIV/TB Co-Infection Unit, Public Health Agency of Canada, Winnipeg, Canada
| | - Sandra A Kiazyk
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada; National Laboratory for HIV Immunology, HIV/TB Co-Infection Unit, Public Health Agency of Canada, Winnipeg, Canada
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Juno JA, Waruk JLM, Mesa C, Lopez C, Bueti J, Ball TB, Kiazyk SA. Maintenance of Mycobacterium tuberculosis-specific T cell responses in End Stage Renal Disease (ESRD) and implications for diagnostic efficacy. Clin Immunol 2016; 168:55-63. [PMID: 27181992 DOI: 10.1016/j.clim.2016.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/09/2016] [Accepted: 05/11/2016] [Indexed: 10/21/2022]
Abstract
End-stage renal disease (ESRD) patients exhibit elevated risk of tuberculosis (TB) reactivation, but current diagnostics, including the interferon gamma release assay (IGRA), exhibit poor sensitivity in ESRD. We tested 80 ESRD patients and found an 18.75% prevalence of IGRA positivity. A subset of patients was assessed for Mtb-specific expression of 44 cytokines/chemokines, and CD4+ T cell phenotype and function. Similar to non-ESRD IGRA+ individuals, Mtb-specific IFNγ, IL-1RA, IP-10, MCP-3 and IL-2 responses were identified in the ESRD IGRA+ group. 27% of the ESRD IGRA- group exhibited MCP-3 or IL-2 Mtb-specific responses, which may identify cases of latent TB infection in ESRD. Stimulation of PBMC with PPD demonstrated similar CD4+ T cell production of IFNγ, TNFα and GM-CSF by ESRD patients. The reported low sensitivity of the IGRA in ESRD cohorts is therefore unlikely to be due to poor T cell cytokine secretion, and may instead reflect defects in antigen presentation.
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Affiliation(s)
- Jennifer A Juno
- Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada; TB-HIV Co-infection Unit, National HIV and Retrovirology Laboratory, JC Wilt Infectious Disease Research Centre, Winnipeg, MB, Canada.
| | - Jillian L M Waruk
- TB-HIV Co-infection Unit, National HIV and Retrovirology Laboratory, JC Wilt Infectious Disease Research Centre, Winnipeg, MB, Canada
| | - Christine Mesa
- TB-HIV Co-infection Unit, National HIV and Retrovirology Laboratory, JC Wilt Infectious Disease Research Centre, Winnipeg, MB, Canada
| | - Carmen Lopez
- Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada
| | - Joe Bueti
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada; Health Sciences Centre Renal Program, Winnipeg, MB, Canada
| | - T Blake Ball
- Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada; TB-HIV Co-infection Unit, National HIV and Retrovirology Laboratory, JC Wilt Infectious Disease Research Centre, Winnipeg, MB, Canada
| | - Sandra A Kiazyk
- Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada; TB-HIV Co-infection Unit, National HIV and Retrovirology Laboratory, JC Wilt Infectious Disease Research Centre, Winnipeg, MB, Canada
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Richmond MEI, Kiazyk SA, Mckinnon LR, Wachihi C, Kimani M, Kimani J, Plummer FA, Ball TB. Evolution of Polyfunctional and Proliferative CD8+ T-cell Responses from Early to Chronic HIV-1 Infection. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5369.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Meika EI Richmond
- University of Manitoba, Medical Microbiology, Winnipeg, MB, Canada
- Public Health Agency of Canada, National Lab for HIV Immunology, Winnipeg, MB, Canada
| | - Sandra A. Kiazyk
- University of Manitoba, Medical Microbiology, Winnipeg, MB, Canada
- Public Health Agency of Canada, National Lab for HIV Immunology, Winnipeg, MB, Canada
| | - Lyle R. Mckinnon
- University of KwaZulu-Natal, Centre for the Programme of AIDS Research in South Africa, Durban, Kenya
| | | | | | | | - Francis A. Plummer
- University of Manitoba, Medical Microbiology, Winnipeg, MB, Canada
- University of Nairobi, Nairobi, Kenya
- Public Health Agency of Canada, National Microbiology Lab, Winnipeg, MB, Canada
| | - T. Blake Ball
- University of Manitoba, Medical Microbiology, Winnipeg, MB, Canada
- Public Health Agency of Canada, National Lab for HIV Immunology, Winnipeg, MB, Canada
- University of Nairobi, Nairobi, Kenya
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Richmond MEI, Kiazyk SA, Mckinnon LR, Nyanga B, Wachihi C, Kimani M, Kimani J, Plummer FA, Ball TB. Identification of CD8+ T-cell Epitopes that Associate with Distinct Functionality, Proliferation and Polyfunctionality. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5370.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Meika EI Richmond
- Public Health Agency of Canada, National Lab for HIV Immunology, Winnipeg, MB, Canada
- University of Manitoba, Medical Microbiology, Winnipeg, MB, Canada
| | - Sandra A. Kiazyk
- Public Health Agency of Canada, National Lab for HIV Immunology, Winnipeg, MB, Canada
- University of Manitoba, Medical Microbiology, Winnipeg, MB, Canada
| | - Lyle R. Mckinnon
- University of KwaZulu-Natal, Centre for the Programme of AIDS Research in South Africa, Durban, Kenya
| | | | | | | | - Joshua Kimani
- University of Manitoba, Medical Microbiology, Winnipeg, MB, Canada
- University of Nairobi, Nairobi, Kenya
| | - Francis A. Plummer
- University of Manitoba, Medical Microbiology, Winnipeg, MB, Canada
- University of Nairobi, Nairobi, Kenya
- Public Health Agency of Canada, National Microbiology Lab, Winnipeg, MB, Canada
| | - T. Blake Ball
- Public Health Agency of Canada, National Lab for HIV Immunology, Winnipeg, MB, Canada
- University of Manitoba, Medical Microbiology, Winnipeg, MB, Canada
- University of Nairobi, Nairobi, Kenya
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