B regulatory cells and monocyte subpopulations in patients with chronic graft-vs-host disease

Abstract

Aim: To assess the correlations of B regulatory cells (Bregs) and monocyte subsets in peripheral blood with the National Institutes of Health (NIH)-consensus-defined clinical manifestations of chronic graft-vs-host disease (cGvHD), in an attempt to establish their role as cellular biomarkers.

Methods: This multidisciplinary prospective study enrolled adult cGVHD patients treated in the University Hospital Center Zagreb and University of Zagreb School of Medicine. Immunophenotypic subpopulations of CD24highCD38high Bregs (CD27-, CD27+, and total) and monocyte (classical, intermediate, and non-classical) counts were correlated with demographic, transplant, and cGVHD-related data. Bivariate correlation analysis was performed to evaluate the correlations between Bregs and monocytes subsets and cGVHD organ involvement, as well as cGVHD severity and immunosuppression intensity.

Results: Twenty-two adult patients (54.5% female) with cGVHD were enrolled. The median (range) age was 44.5 years (24-65). All patients were transplanted for hematologic malignancies and 40.9% had severe NIH cGVHD global score. The median time from cGVHD diagnosis to the analysis was 16.6 months (0-176). The organ most frequently affected with cGVHD were the eyes (68.2%), skin (45.5%), lungs (45.5%), and liver (40.9%). Lower total and CD27-Bregs counts were correlated with worse cGVHD severity, higher immunosuppression intensity, and lung cGVHD, in terms of cell count, but also with skin cGVHD, in terms of percentages. Patients with liver and joint/fascia cGVHD had a lower percentage of non-classical monocytes and patients with more severe global NIH score had a higher classical monocytes count.

Conclusion: Different organs affected by cGVHD are differently associated with different subpopulations of Bregs and monocytes.

Figure 1

(A) Regulatory B cells were gated from CD19 positive cells as CD24++CD38++ cells. (B) Monocyte subpopulations were gated from HLA-DR positive cells according to CD14 and CD16 expression as non-classical (CD14+CD16++), intermediate (CD14++CD16+), and classical monocytes (CD14++CD16-). Abbreviations: HLA-DR– human leukocyte antigen-DR; FITC-A – fluorescein isothiocyanate; SSC-A – side scatter; APC-A –allophycocyanin.

Figure 2

(A) Total regulatory B cell count in patients according to their chronic graft vs host disease lung involvement. (B) Total classical monocytes count in patients according to their global National Institutes of Health score.