Sarcoidosis clinical picture governs alterations in type 17 T helper cell subset composition and cytokine profile

Immune cell hyperactivation along with cytokines they overproduce plays an important role in sarcoidosis and related disease pathogenesis. A central place in the immunopathogenesis of sarcoidosis is held by diverse cell-mediated reactions governed by T helper (Th) cell populations including Th17 subsets and relevant signature cytokines. We studied peripheral blood plasma samples of the patients with sarcoidosis (n = 123): 18% with acute and 82% with chronic course. The control group — samples from healthy volunteers (n = 43). T cell subset composition was assessed by flow cytometry. Cytokine concentrations (pg/mL) were measured by multiplex analysis using xMAP technology (Luminex). The level of “classical” Th17 turned out to be significantly reduced in acute vs chronic sarcoidosis: 28.3% vs 33.3% (p = 0.046). The level of “double-positive” Th17 (DP Th17) was significantly increased in chronic and acute vs control group: 31.7% and 34.2% vs 26.2% (p < 0.001 in both cases), without differences patient inter-group; “non-classical” Th17.1 were shown to have significantly reduced level only in chronic vs healthy subjects: 27.9% and 35.9% (p < 0.001). Clinical and laboratory diagnostic characteristics for blood DP Th17 levels in CD45RA-negative Th effector memory cells in sarcoidosis: in acute sarcoidosis vs healthy subjects, they were characterized by sensitivity — 82%; specificity — 71%, whereas in chronic: 67% and 56%, respectively. In patients with sarcoidosis vs healthy subjects were found to have significantly increased level of IL-12 (p70) — 1.3 vs 0.56, p = 0.028; IL-17A — 1.5 vs 0.43, p < 0.001; IFNγ — 4.1 vs 1.1, p < 0.001; TNFα — 21.7 vs 6.7, p < 0.001. Thus, CCR6⁺ Th17 and DP Th17 subsets and relevant signature cytokines are important in diagnostics of sarcoidosis of varying clinical course: a direct correlation was shown between the level of angiotensin-converting enzyme activity and percentage of memory DP Th17; disease progression vs regression had significantly reduced absolute number of total CD45RA^- memory and CM Th17; extrapulmonary manifestations had a significantly increased percentage of DP Th17 CD45RA^- and EM DP Th17; in chronic sarcoidosis are significantly increased concentration of IL-17A, IFNγ, IL-12 and positively correlation between IFNγ and the activity of angiotensin-converting enzyme.

1. Arger N.K., Ho M.E., Allen I.E., Benn B.S., Woodruff P.G., Koth L.L. CXCL9 and CXCL10 are differentially associated with systemic organ involvement and pulmonary disease severity in sarcoidosis. Respir. Med., 2020, Vol. 161, 105822. doi: 10.1016/j.rmed.2019.105822.

2. Bennett D., Bargagli E., Refini R.M., Rottoli P. New concepts in the pathogenesis of sarcoidosis. Expert Rev. Respir. Med., 2019, Vol. 13, no. 10, pp. 981-991.

3. Broos C.E., Koth L.L., van Nimwegen M., In ‘tVeen J.C.C.M., Paulissen S.M.J., van Hamburg J.P., Annema J.T., Heller-Baan R., Kleinjan A., Hoogsteden H.C., Wijsenbeek M.S., Hendriks R.W., van den Blink B., Kool M. Increased T-helper 17.1 cells in sarcoidosis mediastinal lymph nodes. Eur. Respir. J., 2018, Vol. 51, no. 3, 1701124. doi: 10.1183/13993003.01124-2017.

4. Facco M., Cabrelle A., Teramo A., Olivieri V., Gnoato M., Teolato S., Ave E., Gattazzo C., Fadini G.P., Calabrese F., Semenzato G., Agostini C. Sarcoidosis is a Th1/Th17 multisystem disorder. Thorax, 2011, Vol. 66, no. 2, pp. 144-150.

5. Georas S.N., Chapman T.J., Crouser E.D. Sarcoidosis and T-helper cells. Th1, Th17, or Th17.1? Am. J. Respir. Crit. Care Med., 2016, Vol. 193, no 11, pp. 1198-1200.

6. Hunninghake G.W., Costabel U., Ando M., Baughman R., Cordier J.F., du Bois R., Eklund A., Kitaichi M., Lynch J., Rizzato G., Rose C., Selroos O., Semenzato G., Sharma O.P. ATS/ERS/WASOG statement on sarcoidosis. American thoracic society/European respiratory society/world association of sarcoidosis and other granulomatous disorders. Sarcoidosis Vasc. Diffuse. Lung. Dis., 1999, Vol. 16, no. 2, pp. 149-173.

7. Kudryavtsev I.V., Borisov A.G., Krobinets I.I., Savchenko A.A., Serebriakova M.K., Totolian A.A. Chemokine receptors at distinct differentiation stages of T-helpers from peripheral blood. Medical Immunology (Russia), 2016, Vol. 18, no. 3, pp. 239-250. (In Russ.) doi: 10.15789/1563-0625-2016-3-239-250.

8. Kudryavtsev I.V., Lazareva N.M., Baranova O.P., Serebriakova M.K., Ses' T.P., Ilkovich M.M., Totolian Areg A. Peripheral blood T helper cell subsets in Lofgren's and non-Lofgren's syndrome patients. Medical Immunology (Russia), 2022, Vol. 24, no. 3, pp. 573-586. (In Russ.) doi: 10.15789/1563-0625-PBT-2468.

9. Lazareva N.M., Baranova O.P., Kudryavtsev I.V., Arsentieva N.A., Liubimova N.E., Ses' T.P., Ilkovich M.M., Totolian Areg A. Features of cytokine profile in patients with sarcoidosis. Medical Immunology (Russia), 2020, Vol. 22, no. 5, pp. 993-1002. (In Russ.). doi: 10.15789/1563-0625-FOC-2064.

10. Lazareva N.M., Baranova O.P., Kudryavtsev I.V., Arsentieva N.A., Lyubimova N.E., Ses' T.P., Ilkovich M.M., Totolian Areg A. CXCR3 chemokine receptor ligands in sarcoidosis. Medical Immunology (Russia), 2021, Vol. 23, no. 1, pp. 73-86. (In Russ.). doi: 10.15789/1563-0625-CCR-2181.

11. Loke W.S., Herbert C., Thomas P.S. Sarcoidosis: immunopathogenesis and immunological markers. Int. J. Chronic Dis., 2013, Vol. 2013, 928601. doi: 10.1155/2013/928601.

12. McKee A.S., Atif S.M., Falta M.T., Fontenot A.P. Innate and adaptive immunity in noninfectious granulomatous lung disease. J. Immunol., 2022, Vol. 208, no. 8, 1835-1843.

13. Miedema J.R., Kaiser Y., Broos C.E., Wijsenbeek M.S., Grunewald J., Kool M. Th17-lineage cells in pulmonary sarcoidosis and Lofgren's syndrome: Friend or foe? J. Autoimmun., 2018, Vol. 87, pp. 82-96.

14. Patterson K.C., Chen E.S. The pathogenesis of pulmonary sarcoidosis and implications for treatment. Chest, 2018, Vol. 153, no. 6, pp. 1432-1442.

15. Paulissen S.M., van Hamburg J.P., Dankers W., Lubberts E. The role and modulation of CCR6+ Th17 cell populations in rheumatoid arthritis. Cytokine, 2015, Vol. 74, no. 1, pp. 43-53.

16. Sakthivel P., Bruder D. Mechanism of granuloma formation in sarcoidosis. Curr. Opin. Hematol., 2017, Vol. 24, no. 1, pp. 59-65.

17. Zhang H., Costabel U., Dai H. The Role of diverse immune cells in sarcoidosis. Front. Immunol., 2021, Vol. 12, 788502. doi: 10.3389/fimmu.2021.788502.

18. Zhou E-R., Arce S. Key players and biomarkers of the adaptive immune system in the pathogenesis of sarcoidosis. Int. J. Mol. Sci., 2020, Vol. 21, no. 19, 7398. doi: 10.3390/ijms21197398.