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T lymphocytes have been at the forefront of research in the past decade due to our increasing understanding of their role in the clearance of pathogens, their application in immunotherapy, and the association of their dysregulation with a variety of diseases. A key example is seen with the depletion of T cells, mediated by infections such as from human immunodeficiency virus (HIV) and the severe secondary immune deficiencies that develop, such as acquired immune deficiency syndrome (AIDS).1 In healthy humans, mature T cells and T regulatory cells (Tregs) help in maintaining peripheral immune tolerance, preventing autoimmunity against self antigens. Of recent interest have been immune checkpoint inhibitors targeting T cell receptors, such as PD-1 and CTLA-4, which have been successful in un-inhibiting T cell activation and proliferation of antigen-experienced T cells in the tumor microenvironment. This strategy has been used successfully in treatment against melanoma and other tumors.2 Chimeric antigen receptor (CAR)-T cells, such as anti-CD19 CAR-T cells, have been extremely successful (approximately 93% response) against B cell malignancies, such as acute lymphoblastic leukemia.2 Flow cytometry provides a powerful tool for immunophenotyping and analyzing T cells, furthering insights in each of these fields.

 

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The origin and development of T cells

T cells originate in the bone marrow and travel to the thymus for their maturation. Characteristic markers of T cells are their T cell receptor (TCR) and a ubiquitous member of the TCR complex, CD3. They can further be subsetted into two predominant types by the expression of other surface molecules, CD4 (CD4+ or helper T cells) and CD8 (CD8+ or cytotoxic T cells).3

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Types of T cells

Helper T cells

Helper T (Th) cells are essential regulators of adaptive immune responses and inflammatory diseases. A subgroup of lymphocytes, helper T cells play an important role in establishing and maximizing the capabilities of the immune system. These cells are unusual in that they have little or no cytolytic or phagocytic activity. However, they are involved in activating and directing other immune cells.

 

After activation by professional antigen-presenting cells (APCs) such as dendritic cells, macrophages and B cells, antigen-specific CD4+ T cells differentiate into effector cells that are specialized in terms of the cytokines and effector molecules that they express on their membranes or secrete and their discrete effector functions. Several types of Th cells have been recognized:

 

Th1 cells

Th1 cells are involved in the cellular immune response and host defense against intracellular pathogens. These molecules are characterized by the production of pro-inflammatory cytokines like IFN-γ, IL-2 and lymphotoxin-α (LTα). Th1 cells are centrally involved in cell-mediated immunity. The cytokines produced by Th1 cells stimulate the phagocytosis and destruction of microbial pathogens by macrophages and other lymphocytes. Several chronic inflammatory diseases have been described as Th1-dominant diseases including multiple sclerosis, diabetes and rheumatoid arthritis.

 

Th2 cells

Th2 cells are involved in the humoral immune response and host defense against extracellular parasites. These cells are characterized by the production of IL-4, IL-5, IL-6, IL-10 and IL-13. Th2 cells are thought to play a role in allergic responses. Cytokines like IL-4 generally stimulate the production of antibodies directed toward large extracellular parasites, while IL-5 stimulates eosinophil response toward large extracellular parasites. Allergy and atrophy are thought to be Th2-dominant conditions. Th2 cells have historically been thought to be the source of IL-9. However, recent publications suggest the existence of a Th2-related cell type that is characterized by the secretion of IL-9 and IL-10. These so-called Th9 cells can differentiate from Th2 cells in the presence of TGF-β or they can differentiate from a naïve CD4 cell with a combination of IL-4 and TGF-β. These cells may be involved in asthma and tissue inflammation.

 

The balance between Th1 and Th2 cells

When Th1 cells produce IFN-γ, this prompts macrophages to produce TNF and toxic forms of oxygen, which destroy the microorganisms within the phagosomes and lysosomes. On the other hand, when Th2 cells produce IL-4 and IL-10, these cytokines block the microbial killing that is activated by IFN-γ. The Th1/Th2 relationship has also been investigated with regards to transplantation. Th1 responses have been implicated in most forms of acute graft or transplant rejection and graft-versus-host (GVHD) disease, while Th2 responses have been variably associated with either protection or chronic rejection. However, cloned Th1 or Th2 cells have a similar capacity to reject skin grafts in experimental models, and Tr1/Treg cells are now being implicated in protection and tolerance induction. The fetus is also analogous to an allograft, and Th2 or Treg responses are thought to be protective, while Th1 may lead to resorption or spontaneous abortion. 4

 

Th17 cells

Th17 cells are involved in inflammation and host defense against extracellular pathogens. A subset of helper T cells that produce IL-17A, Th17 cells has been shown to play an important role in the induction of autoimmune tissue injury. They are distinct from Th1 or Th2 cells since they do not produce classical Th1 or Th2 cytokines such as IFN-γ or IL-4. They play a key role in mouse models of autoimmunity, and it has been suggested that the differentiation pathway from a naïve T-helper cell to a Th17 cell involves a combination of TGF-β and IL-6. RORγt is a key transcription factor involved in induction of Th17 cells. Some RORγt expression is induced in response to IL-6 or TGF-β, but the generation of Th17 cells requires TGF-β as well as IL-6.

 

Furthermore, it is believed that the relative balance of IL-6 and TGF-β in steady state would tilt the balance in favor of either Th17 or Treg differentiation in diverse tissues. Induction of the Th17 subset requires TGF-β and IL-6, while amplification of IL-17A–producing cells is dependent upon TGF-β and IL-21. Maintenance of a Th17 response primarily depends on IL-23 (p19/p40). IL-23 binds to the IL-23 receptor that triggers downstream activation of STAT3 and subsequent upregulation of ROR-γ and production of IL-17A.

 

Since IL-17A leads to the induction of many pro-inflammatory factors such as TNF, IL-6 and IL-1β, it has been suggested that Th17 cells might be responsible for the development and/or progression of autoimmune diseases such as experimental autoimmune encephalomyelitis (EAE) and colitis.

 

Regulatory T cells

Regulatory T cells (Tregs) play an important role in maintaining immune homeostasis.2 Tregs suppress the function of other T cells to limit the immune response. Alterations in the number and function of Tregs has been implicated in several autoimmune diseases including multiple sclerosis, active rheumatoid arthritis and type 1 diabetes. High levels of Tregs have been found in many malignant disorders including lung, pancreas and breast cancers. Tregs may also prevent antitumor immune responses,5 leading to increased mortality. 

 

As published data on the immunosuppressive potential of regulatory T cells (Tregs) has accumulated, enthusiasm for their potential application has intensified. Thus, Treg research is very active and new publications emerge almost daily. Today, commonly used markers for Treg identification, isolation and characterization are CD4, CD25, CD127 and FoxP3. However, new targets with functional significance such as CD39, CD45RA, CTLA-4 and others are rapidly emerging.

 

CD4 and CD8 Tregs

Two major classes of Tregs have been identified to date: CD4 and CD8 Tregs. CD4 Tregs consist of two types—natural Tregs (nTregs) that constitutively express CD25 and FoxP3 and so-called adaptive or inducible Tregs (iTregs).

 

Natural Tregs originate from the thymus as CD4+ cells expressing high levels of CD25 together with the transcription factor (and lineage marker) FoxP3. nTregs represent approximately 5–10% of the total CD4+ T cell population and can first be seen at the single-positive stage of T lymphocyte development.6, 7 They are positively selected thymocytes with a relatively high avidity for self-antigens. The signal to develop into Treg cells is thought to come from interactions between the T cell receptor and the complex of MHC II with self peptide expressed on the thymic stroma. nTregs are essentially cytokine independent.

 

Adaptive or inducible Tregs originate from the thymus as single-positive CD4 cells. They differentiate into CD25 and FoxP3 expressing Tregs (iTregs) following adequate antigenic stimulation in the presence of cognate antigen and specialized immunoregulatory cytokines such as TGF-β, IL-10 and IL-4.8

 

FoxP3 is currently the most accepted marker for Tregs,although there have been reports of small populations of FoxP3- Tregs. The discovery of transcription factor FoxP3 as a marker for Tregs has allowed scientists to better define Treg populations leading to the discovery of additional Treg markers including CD127.10

 

CD127 Cells

CD127 is part of the heterodimeric IL-7 receptor that is composed of CD127 and the common gamma chain, which is shared by other cytokine receptors (IL-2R, IL-4R, IL-9R, IL-15R and IL-21R). CD127 is expressed on thymocytes, T and B cell progenitors, mature T cells, monocytes and some other lymphoid and myeloid cells. Studies have shown that IL-7R plays an important role in the proliferation and differentiation of mature T cells, and in vitro experiments show that the expression of CD127 is downregulated following T cell activation.11 It is believed that FoxP3 interacts with the CD127 promoter and might contribute to reduced expression of CD127 in Tregs.

References

  1. McCune JM. The dynamics of CD4+ T-cell depletion in HIV disease. Nature. 2001;410(6831):974-979. doi: 10.1038/35073648

  2. Todryk S, Jozwik A, de Hayilland J, Hester J. Emerging cellular therapies: T cells and beyond. Cells. 2019;8:284. doi:10.3390/cells8030284

  3. Mousset CM, Hobo W, Woestenenk R, Preijers F, Dolstra H, van der Waart AB. Comprehensive phenotyping of T cells using flow cytometry. Cytometry A. 2019;95(6):647-654. doi:10.1002/cyto.a.23724

  4. Qian J, Zhang N, Lin J, et al. Distinct pattern of Th17/Treg cells in pregnant women with a history of unexplained recurrent spontaneous abortion. Biosci Trends. 2018;12(2):157-167. doi:10.5582/bst.2018.01012

  5. Overacre-Delgoffe AE, Chikina M, Dadey RE, et al. Interferon-γ drives Treg fragility to promote anti-tumor immunity. Cell. 2017;169(6):1130-1141.e11. doi:10.1016/j.cell.2017.05.005

  6. Workman CJ, Szymczak-Workman AL, Collison LW, Pillai MR, Vignali DA. The development and function of regulatory T cells. Cell Mol Life Sci. 2009;66(16):2603-2622. doi:10.1007/s00018-009-0026-2

  7. Schiavon V, Duchez S, Branchtein M, et al. Microenvironment tailors nTreg structure and function. Proc Natl Acad Sci U S A. 2019;116(13):6298-6307. doi:10.1073/pnas.1812471116

  8. Liu M, Li S, Li MO. TGF-β control of adaptive immune tolerance: a break from Treg cells. Bioessays. 2018;40(11):e1800063. doi:10.1002/bies.201800063

  9. Lu L, Barbi J, Pan F. The regulation of immune tolerance by FOXP3. Nat Rev Immunol. 2017;17(11):703-717. doi:10.1038/nri.2017.75

  10. Rodríguez-Perea AL, Arcia ED, Rueda CM, Velilla PA. Phenotypical characterization of regulatory T cells in humans and rodents. Clin Exp Immunol. 2016;185(3):281-291. doi:10.1111/cei.12804

  11. Di Caro V, D'Anneo A, Phillips B, et al. Interleukin-7 matures suppressive CD127(+) forkhead box P3(FoxP3)(+) T cells into CD127(-) CD25(high) FoxP3(+) regulatory T cells. Clin Exp Immunol. 2011;165(1):60-76. doi: 10.1111/j.1365-2249.2011.04334.x
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