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- Title
T cells from patients with Candida sepsis display a suppressive immunophenotype.
- Authors
Spec, Andrej; Yuichiro Shindo; Burnham, Carey-Ann D.; Wilson, Strother; Ablordeppey, Enyo A.; Beiter, Evan R.; Katherine Chang; Drewry, Anne M.; Hotchkiss, Richard S.; Shindo, Yuichiro; Chang, Katherine
- Abstract
<bold>Background: </bold>Despite appropriate therapy, Candida bloodstream infections are associated with a mortality rate of approximately 40%. In animal models, impaired immunity due to T cell exhaustion has been implicated in fungal sepsis mortality. The purpose of this study was to determine potential mechanisms of fungal-induced immunosuppression via immunophenotyping of circulating T lymphocytes from patients with microbiologically documented Candida bloodstream infections.<bold>Methods: </bold>Patients with blood cultures positive for any Candida species were studied. Non-septic critically ill patients with no evidence of bacterial or fungal infection were controls. T cells were analyzed via flow cytometry for cellular activation and for expression of positive and negative co-stimulatory molecules. Both the percentages of cells expressing particular immunophenotypic markers as well as the geometric mean fluorescence intensity (GMFI), a measure of expression of the number of receptors or ligands per cell, were quantitated.<bold>Results: </bold>Twenty-seven patients with Candida bloodstream infections and 16 control patients were studied. Compared to control patients, CD8 T cells from patients with Candidemia had evidence of cellular activation as indicated by increased CD69 expression while CD4 T cells had decreased expression of the major positive co-stimulatory molecule CD28. CD4 and CD8 T cells from patients with Candidemia expressed markers typical of T cell exhaustion as indicated by either increased percentages of or increased MFI for programmed cell death 1 (PD-1) or its ligand (PD-L1).<bold>Conclusions: </bold>Circulating immune effector cells from patients with Candidemia display an immunophenotype consistent with immunosuppression as evidenced by T cell exhaustion and concomitant downregulation of positive co-stimulatory molecules. These findings may help explain why patients with fungal sepsis have a high mortality despite appropriate antifungal therapy. Development of immunoadjuvants that reverse T cell exhaustion and boost host immunity may offer one way to improve outcome in this highly lethal disorder.
- Subjects
CANDIDA; IMMUNOSUPPRESSION; LONGITUDINAL method; T cells; PHENOTYPES; CANDIDEMIA
- Publication
Critical Care, 2016, p1
- ISSN
1364-8535
- Publication type
journal article
- DOI
10.1186/s13054-016-1182-z