Dhalla F, Fox H, Davenport E E, Sadler R, Anzilotti C, van Schouwenburg P A, Ferry B, Chapel H, Knight J C, Patel S Y
Department of Clinical Immunology, John Radcliffe Hospital, Oxford, UK.
Department of Clinical Laboratory Immunology, Churchill Hospital, Oxford, UK.
Clin Exp Immunol. 2016 May;184(2):216-27. doi: 10.1111/cei.12746. Epub 2016 Feb 9.
Chronic mucocutaneous candidiasis (CMC) is characterized by recurrent and persistent superficial infections, with Candida albicans affecting the mucous membranes, skin and nails. It can be acquired or caused by primary immune deficiencies, particularly those that impair interleukin (IL)-17 and IL-22 immunity. We describe a single kindred with CMC and the identification of a STAT1 GOF mutation by whole exome sequencing (WES). We show how detailed clinical and immunological phenotyping of this family in the context of WES has enabled revision of disease status and clinical management. Together with analysis of other CMC cases within our cohort of patients, we used knowledge arising from the characterization of this family to develop a rapid ex-vivo screening assay for the detection of T helper type 17 (Th17) deficiency better suited to the routine diagnostic setting than established in-vitro techniques, such as intracellular cytokine staining and enzyme-linked immunosorbent assay (ELISA) using cell culture supernatants. We demonstrate that cell surface staining of unstimulated whole blood for CCR6⁺ CXCR3⁻ CCR4⁺ CD161⁺ T helper cells generates results that correlate with intracellular cytokine staining for IL-17A, and is able to discriminate between patients with molecularly defined CMC and healthy controls with 100% sensitivity and specificity within the cohort tested. Furthermore, removal of CCR4 and CD161 from the antibody staining panel did not affect assay performance, suggesting that the enumeration of CCR6⁺ CXCR3⁻ CD4⁺ T cells is sufficient for screening for Th17 deficiency in patients with CMC and could be used to guide further investigation aimed at identifying the underlying molecular cause.
慢性黏膜皮肤念珠菌病(CMC)的特征是反复持续的浅表感染,白色念珠菌感染影响黏膜、皮肤和指甲。它可因原发性免疫缺陷而获得或引发,尤其是那些损害白细胞介素(IL)-17和IL-22免疫的缺陷。我们描述了一个患有CMC的家系,并通过全外显子组测序(WES)鉴定出一种信号转导和转录激活因子1(STAT1)功能获得性突变。我们展示了在WES背景下对该家系进行详细的临床和免疫表型分析如何能够修订疾病状态和临床管理。结合我们患者队列中其他CMC病例的分析,我们利用对该家系特征的了解开发了一种快速体外筛选试验,用于检测17型辅助性T细胞(Th17)缺陷,该试验比现有的体外技术(如细胞内细胞因子染色和使用细胞培养上清液的酶联免疫吸附测定(ELISA))更适合常规诊断环境。我们证明,对未刺激的全血进行CCR6⁺ CXCR3⁻ CCR4⁺ CD161⁺辅助性T细胞的细胞表面染色所产生的结果与IL-17A的细胞内细胞因子染色相关,并且在测试队列中能够以100%的敏感性和特异性区分分子定义的CMC患者和健康对照。此外,从抗体染色组合中去除CCR4和CD161并不影响试验性能,这表明CCR6⁺ CXCR3⁻ CD4⁺ T细胞的计数足以筛查CMC患者的Th17缺陷,并可用于指导旨在确定潜在分子原因的进一步调查。
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