Bronchoalveolar Tregs are associated with duration of mechanical ventilation in acute respiratory distress syndrome.

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2020-11

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Abstract

Background

Foxp3+ regulatory T cells (Tregs) play essential roles in immune homeostasis and repair of damaged lung tissue. We hypothesized that patients whose lung injury resolves quickly, as measured by time to liberation from mechanical ventilation, have a higher percentage of Tregs amongst CD4+ T cells in either airway, bronchoalveolar lavage (BAL) or peripheral blood samples.

Methods

We prospectively enrolled patients with ARDS requiring mechanical ventilation and collected serial samples, the first within 72 h of ARDS diagnosis (day 0) and the second 48-96 h later (day 3). We analyzed immune cell populations and cytokines in BAL, tracheal aspirates and peripheral blood, as well as cytokines in plasma, obtained at the time of bronchoscopy. The study cohort was divided into fast resolvers (FR; n = 8) and slow resolvers (SR; n = 5), based on the median number of days until first extubation for all participants (n = 13). The primary measure was the percentage of CD4+ T cells that were Tregs.

Results

The BAL of FR contained more Tregs than SR. This finding did not extend to Tregs in tracheal aspirates or blood. BAL Tregs expressed more of the full-length FOXP3 than a splice variant missing exon 2 compared to Tregs in simultaneously obtained peripheral blood.

Conclusion

Tregs are present in the bronchoalveolar space during ARDS. A greater percentage of CD4+ cells were Tregs in the BAL of FR than SR. Tregs may play a role in the resolution of ARDS, and enhancing their numbers or functions may be a therapeutic target.

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Bronchoalveolar Lavage Fluid, Humans, Respiration, Artificial, Bronchoalveolar Lavage, T-Lymphocytes, Regulatory, Respiratory Distress Syndrome

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https://hdl.handle.net/10161/31280

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https://creativecommons.org/licenses/by-nc/4.0

Published Version (Please cite this version)

10.1186/s12967-020-02595-3

Publication Info

Norton, Dustin L, Agathe Ceppe, Miriya K Tune, Matthew McCravy, Thomas Devlin, M Bradley Drummond, Shannon S Carson, Benjamin G Vincent, et al. (2020). Bronchoalveolar Tregs are associated with duration of mechanical ventilation in acute respiratory distress syndrome. Journal of translational medicine, 18(1). p. 427. 10.1186/s12967-020-02595-3 Retrieved from https://hdl.handle.net/10161/31280.

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McCravy

Matthew Scott McCravy

Medical Instructor in the Department of Medicine

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