ABSTRACTchondria but is released following MOMP. BH3 profiling thus provides an assessment of mitochondrial susceptibility to MOMP that integrates the functional activity of all of the BCL2 family proteins that regulate the intrinsic apoptosis pathway in individual cells. This method also allows us to simultaneously compare BH3 peptideinduced mitochondrial membrane depolarization ('priming') in different T-cell subsets: Treg, conventional CD4 T cells (Tcon), and CD8 T cells. Using this approach, our analysis of apoptotic pathways demonstrated that Treg are more susceptible to apoptosis through both intrinsic and extrinsic pathways than other T-cell subsets. This difference is evident in healthy donors indicating that increased susceptibility to apoptosis is reflective of normal Treg homeostasis. In addition, mitochondrial apoptotic priming of Treg and other T-cell subsets is significantly increased after HSCT and particularly in patients with active chronic GvHD (cGvHD).
Methods
Patients and sample collectionBlood samples were obtained from 57 patients who had undergone allogeneic HSCT at the Dana-Farber Cancer Institute and Brigham and Women's Hospital (Boston, MA, USA). Written informed consent was obtained from each patient before sample collection in accordance with the Declaration of Helsinki. This protocol has been reviewed and approved by the Institutional Review Board of the Dana-Farber Harvard Cancer Center. The severity of cGvHD was classified according to NIH criteria. We also studied 25 healthy individuals.
BH3 profiling assayThe BH3 profiling assay has been previously described. 21,25,26 PBMC were incubated with anti-CD4, anti-CD25, anti-CD127, and anti-CD8 at 4°C for 20 min. After incubation, 2.4 x 10 6 cells were washed and suspended in T-EB Buffer. 26 Individual BH3 peptides were added to 50 μl of cell suspension for 30 min at room temperature. After incubation, 12.5 μl of 22.5 µM TMRE (Invitrogen) was added for 30 min. 25 Cells were analyzed on the BD LSRFortessa using FACS Diva software (BD Biosciences). CD4 T-cell subsets were defined by surface antigen expression: Tcon as CD4 + CD25 neg-low CD127 med
Other methodsAdditional flow cytometry methods are detailed in the Online Supplementary Methods.
Statistical analysisDescriptive statistics were used for patients' and transplantrelated characteristics. Fisher's exact test or a c 2 test was used for group comparisons for categorical variables in Table 1. The Wilcoxon rank sum test was used for pair-wise group comparisons for continuous variables. The Wilcoxon signed test was used for the difference in BH3 profiling, expression levels of BCL2 family proteins and proliferation and functional assays between two Tcell subsets within the same blood samples. For the Wilcoxon signed test, percent change was calculated between two T-cell subsets and an absolute change of 10% or higher was regarded as significantly different between two T-cell subsets. Multivariate linear regression analysis was also performed to compare T-cell subsets after adjusting for...