Regulatory T-cell dysfunctions are associated with increase in tumor necrosis factor α in autoimmune hemolytic anemia and participate in Th17 polarization

Haematologica. 2024 Feb 1;109(2):444-457. doi: 10.3324/haematol.2023.282859.

Abstract

Warm autoimmune hemolytic anemia (wAIHA) is a rare acquired autoimmune disease mediated by antibodies targeting red blood cells. The involvement of CD4 T-helper cells has been scarcely explored, with most findings extrapolated from animal models. Here, we performed quantification of both effector T lymphocytes (Teff) and regulatory T cells (Treg), associated with functional and transcriptomic analyses of Treg in human wAIHA. We observed a shift of Teff toward a Th17 polarization concordant with an increase in serum interleukin-17 concentration that correlates with red blood cell destruction parameters, namely lactate dehydrogenase and bilirubin levels. A decrease in circulating Treg, notably effector Treg, associated with a functional deficiency, as represented by their decrease capability to inhibit Teff proliferation, were also observed. Treg deficiency was associated with a reduced expression of Foxp3, the master transcription factor known to maintain the Treg phenotype stability and suppressive functions. Transcriptomic profiling of Treg revealed activation of the tumor necrosis facto (TNF)-α pathway, which was linked to increased serum TNF-α concentrations that were twice as high as in controls. Treg transcriptomic profiling also suggested that post-translational mechanisms possibly accounted for Foxp3 downregulation and Treg dysfunctions. Since TNF-α participates in the rupture of immune tolerance during wAIHA, its inhibition could be of interest. To this end, the effects of fostamatinib, a SYK inhibitor, were investigated in vitro, and we showed that besides the inhibition of erythrocyte phagocytosis by monocytes, fostamatinib is also able to dampen TNF-α production, thus appearing as a promising multitargeting therapy in wAIHA (clinicaltrials gov. Identifier: NCT02158195).

MeSH terms

  • Aminopyridines*
  • Anemia, Hemolytic, Autoimmune*
  • Animals
  • Forkhead Transcription Factors / metabolism
  • Humans
  • Morpholines*
  • Pyrimidines*
  • T-Lymphocytes, Regulatory*
  • Th17 Cells
  • Tumor Necrosis Factor-alpha

Substances

  • Tumor Necrosis Factor-alpha
  • fostamatinib
  • Forkhead Transcription Factors
  • Aminopyridines
  • Morpholines
  • Pyrimidines

Associated data

  • ClinicalTrials.gov/NCT02158195

Grants and funding

Funding: This investigation was supported by a research grant (2012-A001154-39) from the GIRCI Est (Groupement Interrégional pour la Recherche Clinique et l’Innovation), by the French Ministry of Health and Solidarity (Referral Centers for Rare Diseases), and by the French National Institute of Health and Medical Research (INSERM). The flow cytometry core facility is supported by the Burgundy Regional Council.