Control lymphocyte subsets: can one country's values serve for another's?

Abstract

Lymphocyte subsets can be affected by host and environmental factors, yet direct comparisons of their patterns across continents are lacking. This work compares proportions and counts of lymphocyte subsets between healthy children from Thailand, Malawi and the USA. We analyzed subsets of 1,399 healthy children aged between 0 and 15 years: 281 Thai, 397 Malawian and 721American children. Existing data for five subsets were available for all three cohorts (Total T, CD4+ T, CD8+ T, natural killer (NK) and B cells), with data for another six subsets from the Thai and American cohorts (naïve, memory and activated CD4+ and CD8+ T cells). Cellular patterns between cohorts differed mainly in children under two years. Compared to American children, Thai children had higher median numbers of total T cells, CD8+ T cells and NK cells while Malawian children under 18 months, on average, had more CD8+ T cells and B cells. Both Thai and Malawian children had lower median CD4+ T cell percentages and CD4/CD8 ratios than American children. Thai children had more memory and activated CD8+ T cells than American children. Approximately one-fifth of Thai and Malawian HIV-uninfected healthy children aged 0-3 years met WHO-defined CD4+ count criteria for immune-deficiency in HIV-infected children. Healthy children from Thailand, Malawi and the USA have differences in lymphocyte subsets that are likely to be due to differences in ethnicity, exposure to infectious diseases and environmental factors. These results indicate the need for country-specific reference ranges for diagnosis and management of immunologic disorders.

Figure 1

A-D: Box plots of total T cell, CD4+ T cell, CD8+ T cell and total B cell counts (box goes from 25^th-75^th percentile, median is line in the box, and whiskers extend from 10^th-90^th percentiles) in children by Country cohort and age group. Pairwise comparisons between lymphocyte subset distributions of children from each country were made in each age group, using a Mann-Whitney-Wilcoxon test, and P values < 0.05 were considered significant. * indicates a significant difference in the Malawian or Thai (depending on the bar below the symbol) versus the US cohort; # indicates a significant difference from the Malawian cohort versus the Thai cohort.