The phenotypic distribution and functional profile of tuberculin-specific CD4 T-cells characterizes different stages of TB infection

BACKGROUND: Recent publications have suggested that altered proportions of functional CD4 T-cell subsets correlate with active pulmonary TB. Also, CD27-expression on tuberculin-activated IFN-gamma(+) CD4 T-cells is known to differ significantly between patients with active pulmonary TB and healthy TB-unexposed BCG vaccinees. Here, we explore links between CD4 T-cell phenotype, multiple functional subsets, and control of TB. METHODS: We examined ex-vivo overnight tuberculin activated CD4 T-cells in regards to CD27-expression and the activation markers, CD154 upregulation, IFN-gamma, TNF-alpha, IL-2, and degranulation in 44 individuals, including cases of clinically active pulmonary TB, and hospital staff with prolonged TB exposure, some of whom had latent TB. RESULTS: Active pulmonary TB generally showed an excess of TNF-alpha(+) subsets over IFN-gamma(+) subsets, paralleled by decreased CD27 expression on activated IFN-gamma(+) or CD154(+) CD4 T-cells. The single subset distinguishing best between active pulmonary TB and high TB exposure was CD154(+) /TNF-alpha(+) / IFN-gamma(-) /IL-2(-) /degranulation(-) (AUROC 0.90). The ratio between the frequencies of TNF-alpha(+) /IFN-gamma(+) CD4 T-cells was an effective alternative parameter (AUROC 0.87). CONCLUSIONS: Functional subsets and phenotype of tuberculin induced CD4 T-cells differ between stages of TB infection. Predominance of TNF-alpha(+) CD4 T-cells in active infection suggests an increased effort of the immune system to contain disease. (c) 2012 International Clinical Cytometry Society.