First report of expansion of CD4+/CD28 null T-helper lymphocytes in adult patients with idiopathic autoimmune hemolytic anemia

Soha R Youssef, Walaa A Elsalakawy, Soha R Youssef, Walaa A Elsalakawy

Abstract

CD28 null T helper (Th) cells are rare in healthy individuals, but they are increased in various inflammatory and immune-mediated diseases. In this study, we determined the size of the CD4+/CD28 null T lymphocyte compartment in the peripheral blood of 40 autoimmune hemolytic anemia (AIHA) patients (idiopathic and secondary) and 20 healthy control subjects, using tri-color flow cytometry. The frequency and absolute count of CD4+/CD28 null T helper (Th) cells was significantly higher in idiopathic AIHA patients, compared to healthy controls (p = 0.001 and 0.001, respectively) and to patients with secondary AIHA (p = 0.04 and 0.01, respectively). The percentage of CD4+/CD28 null Th cells was also negatively correlated to the hemoglobin (Hb) level (p = 0.03). These findings demonstrate, for the first time, the expansion of this phenotypically-defined population of T lymphocytes in patients with idiopathic AIHA and indicate that it likely plays an etiological role in the development of this disease. However, establishing the use of this marker for diagnosis or monitoring treatment of such patients needs further studies.

Keywords: Autoimmune hemolytic anemia; Autoimmunity; CD4 helper T cells; CD4(+)/CD28 null T lymphocyte; Flow cytometry; T lymphocytes; T(h) cells.

Copyright © 2020 Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. Published by Elsevier España, S.L.U. All rights reserved.

Figures

Figure 1
Figure 1
Comparison between controls and patient groups in relation to compartments of T helper effector populations. This figure shows that the percentage of CD4+CD28 null T cells was significantly higher among group 1 (idiopathic AIHA) patients (median percentage of 10.6%), compared to controls (median percentage of 2.2%) (p = 0.001 and 0.001, respectively) and to group 2 (secondary AIHA) patients (median percentage of 3.7%) (p = 0.04 and 0.01, respectively). The percentage of CD4+CD28− T cells in group 2 patients were comparable to the control group (p > 0.05 and p > 0.05, respectively).

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