Increased naive CD4+ and B lymphocyte subsets are associated with body mass loss and drive relative lymphocytosis in anorexia nervosa patients

Abstract

Anorexia nervosa (AN) is an atypical form of malnutrition with peculiar changes in the immune system. We hypothesized that different lymphocyte subsets are differentially affected by malnutrition in AN, and thus, our aim was to investigate the influence of body mass loss on the variability of lymphocyte subsets in AN patients. A group of 66 adolescent female patients, aged 12-17 years, referred for their first episode of either AN or feeding or eating disorders not elsewhere classified were studied upon admission (46 AN-restricting subtype, 11 AN-binge/purging subtype, and 9 feeding or eating disorders not elsewhere classified). Ninety healthy adolescents served as controls. White blood cells and lymphocyte subsets were analyzed by flow cytometry. Relationships with the body mass index (BMI) z score were assessed in linear models adjusted by diagnostic subtype and age. Leukocyte numbers were lower in AN patients than in controls, and relative lymphocytosis was observed in AN-restricting subtype. Lower CD8, NK, and memory CD8 counts were found in eating disorder patients compared with controls. No differences were found for CD4 counts or naive and memory CD4 subsets between the groups. Negative associations between lymphocyte percentage and the BMI z score, as well as between the B cell counts, naive CD4 percentage and counts, and the BMI z score, were found. In conclusion, increased naive CD4 and B lymphocyte subsets associated with body mass loss drive the relative lymphocytosis observed in AN patients, which reflects an adaptive mechanism to preserve the adaptive immune response.

Anorexia Nervosa and the Immune System—A Narrative Review

“…Furthermore, C3 levels appear to correlate with nutritional status, improving with weight restoration [67,68]. NK cell quantity is reduced in anorexia nervosa when compared to the controls [69,70,71], but NK cell activity seems intact based on the few studies completed [72,73]. DC and macrophage function in anorexia nervosa are unstudied.…”

“…T cell subtypes also appear to be “dysregulated” when comparing anorexia nervosa to primary malnutrition. The CD4/CD8 ratio in anorexia nervosa is seemingly increased, and this appears due to a greater reduction in CD8 counts compared to CD4 counts [70,77,81,82]. Elegido et al [70] and Mustafa et al [81] both attributed this abnormality in CD8 counts to a statistically significant decrease in memory CD8 cells as opposed to naïve CD8 cells ( p < 0.01).…”

“…The CD4/CD8 ratio in anorexia nervosa is seemingly increased, and this appears due to a greater reduction in CD8 counts compared to CD4 counts [70,77,81,82]. Elegido et al [70] and Mustafa et al [81] both attributed this abnormality in CD8 counts to a statistically significant decrease in memory CD8 cells as opposed to naïve CD8 cells ( p < 0.01). Nagata et al [77] also found greater elevation in the CD4/CD8 ratio with more significant weight loss ( p < 0.05); indeed, these researchers suggest that with greater depletion in body weight, lymphocyte production is prioritized over other immune cells, especially naïve T helper cells, in the attempt to preserve the efficacy of the adaptive immune system [77].…”

Malnutrition Accelerates Colorectal Cancer Progression through Macrophage Activated by B Cells Immune via Gut Microbiota

“…B cells have been demonstrated as an essential factor associated with malnutrition [23,24]. Previous research showed under anorexia nervosa, increased number of B lymphocyte associated with body mass loss drives the relative lymphocytosis, leading to the poor outcome [25]. Many studies have discovered the prognostic role of B cells in CRC on malnutrition status, yet how the B cells regulated the malnutrition still remain unknown.…”

The adolescent onset anorexia nervosa study (ANABEL): Design and baseline results

“…The most significant alterations encountered are leukopenia, granulocyte function alterations, and a depletion of T lymphocytes, both helper (CD4+) and cytotoxic (CD8+) T cells, as well as natural killer cells (CD16+/56+). Furthermore, a decrease of the CD4/CD8 ratio, which is considered a good marker of nutritional status, may be observed (Elegido et al, 2017;Marcos, Varela, Santacruz, Muñoz-Vélez, & Morandé, 1993). However, the interaction between biological processes and psychological/psychiatric development predictors remains unclear.…”