IntroductionSince their discovery 15 years ago, 1 it is now well established that CD25 ϩ regulatory T cells (Tregs) are indispensable for immune homeostasis and self-tolerance. Tregs suppress the activation, proliferation, and effector functions of a wide range of immune cells via multiple mechanisms. 2 FOXP3 has been identified as a master transcription factor, controlling both Treg development and functionality. 3,4 In addition, human Tregs can be identified by high CD25 and low IL-7 receptor (CD127) expression. 5,6 A critical role of Tregs in controlling autoimmune responses is demonstrated in various animal models of autoimmune disease. 7 Furthermore, lack of functional Tregs leads to severe, systemic autoimmunity in humans. 8,9 Because of their unique function, Tregs are considered important for the treatment of autoimmune disease, and several strategies are now being explored to target these cells for therapeutic purposes. 10 However, there is still an ongoing debate whether the numbers and/or function of Tregs are changed in patients suffering from chronic autoimmune inflammation. 11 In rheumatoid arthritis (RA) and multiple sclerosis, similar Treg numbers,12,13 or even enhanced numbers in RA, 14 were observed in peripheral blood (PB) of patients compared with healthy controls (HCs). Thus, it appears that Treg numbers are not reduced in patients suffering from autoimmune inflammation. In addition, it remains unclear whether Treg function is impaired; some studies report reduced functioning of Tregs in PB of patients, 12,13,15 whereas others have found no difference. 14,16 In addition to these discrepancies concerning Treg numbers and function in the periphery, characterization of Tregs functionality at the site of autoimmune inflammation in humans is missing. High levels of Tregs have been found at the inflammatory sites in patients with arthritis and inflammatory bowel disease and these cells can suppress CD4 ϩ CD25 Ϫ effector cells in vitro. 17 Also at the site of inflammation in juvenile idiopathic arthritis (JIA), one of the most common childhood autoimmune diseases, we have previously shown that Tregs are present in high numbers and suppress proliferation of CD4 ϩ CD25 Ϫ effector cells in vitro. 18 However, in vivo inflammation persists despite the large numbers of Tregs present, suggesting that these cells are defective in their ability to control the ongoing autoimmune response. This may result from the local proinflammatory environment, because in vitro experiments have shown that pro-inflammatory cytokines can affect both Treg function 15,[19][20][21] as well as effector T-cell responses. 22,23 These data suggest that increasing Treg numbers or enhancing function for therapeutic purposes might be less effective in a chronic inflammatory environment. However, ex vivo data from patients with autoimmune disease are required to clarify the role of Tregs at the site of inflammation in humans.Here, we studied Treg function at the site of inflammation in patients with JIA and compared their inhibitory p...

Juvenile dermatomyositis (JDM) is a rare form of childhood autoimmune myositis that presents with proximal muscle weakness and skin rash. B cells are strongly implicated in the pathogenesis of the disease, but the underlying mechanisms are unknown. Therefore, the main objective of our study was to investigate mechanisms driving B cell lymphocytosis and define pathological features of B cells in JDM patients. Patients were recruited through the UK JDM Cohort and Biomarker study. Peripheral blood B cell subpopulations were immunophenotyped by flow cytometry. The results identified that immature transitional B cells were significantly expanded in active JDM, actively dividing, and correlated positively with disease activity. Protein and RNAseq analysis revealed high interferon alpha (IFNα) and TLR7-pathway signatures pre-treatment. Stimulation of B cells through TLR7/8 promoted both IL-10 and IL-6 production in controls but failed to induce IL-10 in JDM patient cells. Interrogation of the CD40–CD40L pathway (known to induce B cell IL-10 and IL-6) revealed similar expression of IL-10 and IL-6 in B cells cultured with CD40L from both JDM patients and controls. In conclusion, JDM patients with active disease have a significantly expanded immature transitional B cell population which correlated with the type I IFN signature. Activation through TLR7 and IFNα may drive the expansion of immature transitional B cells in JDM and skew the cells toward a pro-inflammatory phenotype.

The tumor immune microenvironment determines clinical outcome. Whether the original tissue in which a primary tumor develops influences this microenvironment is not well understood. We applied high-dimensional single-cell mass cytometry [Cytometry by Time-Of-Flight (CyTOF)] analysis and functional studies to analyze immune cell populations in human papillomavirus (HPV)-induced primary tumors of the cervix (cervical carcinoma) and oropharynx (oropharyngeal squamous cell carcinoma, OPSCC). Despite the same etiology of these tumors, the composition and functionality of their lymphocytic infiltrate substantially differed. Cervical carcinoma displayed a 3-fold lower CD4:CD8 ratio and contained more activated CD8CD103CD161 effector T cells and less CD4CD161 effector memory T cells than OPSCC. CD161 effector cells produced the highest cytokine levels among tumor-specific T cells. Differences in CD4 T-cell infiltration between cervical carcinoma and OPSCC were reflected in the detection rate of intratumoral HPV-specific CD4 T cells and in their impact on OPSCC and cervical carcinoma survival. The peripheral blood mononuclear cell composition of these patients, however, was similar. The tissue of origin significantly affects the overall shape of the immune infiltrate in primary tumors.

Use of biomarkers in clinical practice has proved extremely valuable and is a rapidly expanding field. However, despite the huge potential of biomarkers, for juvenile idiopathic arthritis (JIA) there are currently no validated paediatric biomarkers available to help with setting up a more tailored approach on which drug choice could be based, to achieve remission early in the course of disease. Early remission reduces burden of disease, limits side effects from toxic and unnecessary medication, and, most importantly, enhances quality of life. Several studies have suggested promising biomarkers: these may be a protein, cellular component, mRNA, or genetic component, for example a single nucleotide polymorphism (SNP). Here we describe recent developments in the use of biomarkers for JIA and their potential to assist in management of disease by predicting disease phenotype, severity, progression, and response to treatment, and determining when patients have reached stable remission and can safely discontinue treatment.