Defining the T Cell and Innate Lymphoid Cell Signature in Childhood Arthritis
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Defining the T Cell and Innate Lymphoid Cell Signature in Childhood Arthritis Hannah R G Lom A thesis submitted for the degree of Doctor of Philosophy to University College London 2017 Infection, Inflammation and Rheumatology Section Infection, Immunity, Inflammation Programme UCL Great Ormond Street Institute of Child Health University College London Declaration I, Hannah R G Lom, confirm that the work presented in this thesis is my own. Where information has been derived from other sources, I confirm that this has been indicated in the thesis. 2 Abstract Pathogenesis of juvenile idiopathic arthritis (JIA) is linked to the IL-23/IL-17 axis. This is of particular interest as new biological drugs targeting this pathway have been developed and may prove a useful treatment. Increased IL-17+CD4+ T cells have been reported in the joints of patients with JIA, but less is known about IL-17 production from other cell types. Innate lymphoid cells (ILC) bridge innate and adaptive immune systems and are sub-divided into 3 types (1,2 and 3), which mirror CD4+T- cell subsets. This thesis aimed to investigate T cell and ILC contribution to the disease phenotype in the joints of patients with JIA. Using a combination of flow cytometry techniques along with multiplex cytokine analysis, qPCR and culture assays this study has assessed the immune phenotype of patients with JIA. Significant enrichments of IL-17A+ CD4+, CD8 and γδ T cells were observed in the synovial fluid of patients compared to blood, which correlated with disease severity. In parallel, a significant difference was seen between relative proportions and functionality of ILC subpopulations in the synovial fluid of patients compared to blood. IL17+ILC3 and IL-22+ILC3 were significantly enriched at the inflamed site. These two ILC3 populations were negatively correlated suggesting interplay between the two groups. Additionally, IL-17+ILC3 were associated with more severe disease. Further exploration of immune cells found a significant enrichment of myeloid DC (mDC), which strongly correlated with IL-22+ILC3 at the inflamed site. It was shown that synovial mDC produce retinoic acid which may contribute to skewing of ILC populations. These data suggest a strong IL-17A signature in JIA patients, which extends beyond the T cell compartment. Therefore, therapies targeting the IL-17/IL-23 axis could also attenuate ILC populations within the inflamed joint. Finally, these data suggest that IL22+ILC3 populations are induced by mDC and may be protective in disease. 3 Acknowledgements I would like to thank my Primary supervisor Professor Lucy Wedderburn, for taking a chance on me to complete this PhD. Thank you for guidance and enthusiasm throughout my PhD! Thank you for welcoming me into the Arthritis Research UK Centre for Adolescent Rheumatology, whose mission and work in the field is truly inspiring. I am so proud to have been a part of the centre from the beginning and am privileged to have worked as part of such an inclusive and committed team! I also thank my two secondary supervisors Dr Mona Bajaj- Elliott and Dr Yiannis Ioannou. I am particularly grateful to Mona for always making time to meet with me and for supporting me both technically and emotionally – I couldn’t have got through this without you! I am eternally grateful to Dr David Bending, who has been a great friend and an inspiration to me throughout my PhD. I am so lucky to have had your support and mentorship. Thank you for your continued guidance and patience over the last 4 years! Thanks also to all the members of the Wedderburn group and the 6th floor for your help and friendship and for generally being great fun. Particular thanks to the data managers for recruiting patients and collecting samples, and the healthy volunteers, patients and their parents, without whom none of this work could have been possible. Most importantly, I would like to thank my friends and family for their continued encouragement throughout. Thank you Mum for not humouring my (occasional) negativity and for many motivational pep talks. Josh and Jules, thank you for championing me over the last few years! And to my friends- thank you for picking me up when I have been down, and celebrating with me when I have succeeded. I couldn’t ask for more wonderful cheerleaders! I would like to dedicate this thesis to my Dad, whose relentless enthusiasm for the pursuit of knowledge has been a constant inspiration and has kept me focused and grounded during the course of my PhD. 4 Abbreviations AHR Aryl hydrocarbon receptor Ab Antibody aHC Adult healthy control APC Allophycocyanin APCs Antigen presenting cells AS Ankylosing spondylitis ATRA All-trans retinoic acid BV Brilliant violet CCL CC chemokine ligand CCR CC chemokine receptor CD Cluster of differentiation cHC Child healthy control cKIT Stem cell growth factor receptor CRTH2 Prostaglandin D2 receptor 2 CTL Cytotoxic T lymphocyte CTLA4 Cytotoxic T lymphocyte antigen 4 CXCL CXC chemokine ligand CXCR CXC chemokine receptor Cy Cyanine D Diversity segment encoding TCR chain DAPI 4',6-diamidino-2-phenylindole DC Dendritic cells DMSO Dimethylsulfoxide DMSO Dimethylsulphoxide EAE Experimental autoimmune encephalomyelitis EDTA Ethylenediaminetetraacetic acid EOMES Eomesodermin ERA Enthesitis-related arthritis ESR Erythrocyte sedimentation rate FACS Fluorescent activated cell sorting 5 FCS Foetal calf serum FITC Fluorescein isothiocyanate FOXP3 Forkhead box P3 g Gravity GATA3 GATA binding protein 3 GM-CSF Granulocyte-macrophage colony-stimulating factor GOSH Great Ormond Street Hospital HLA Human leukocyte antigen IBD Inflammatory bowel disease IFN Interferon IL Interleukin ILAR International league of associations for rheumatology ILC Innate lymphoid cells J Joining segment encoding TCR chain JIA Juvenile Idiopathic Arthritis KIR Killer-cell immunoglobulin-like receptor LPS Lipopolysaccharide MAMPs Microbe-associated molecular patterns mDC Myeloid dendritic cells MFI Mean fluorescence intensity MHCI Major histocompatibility complex I MHCII Major histocompatibility complex II MS Multiple sclerosis MTX Methotrexate NCR Natural cytotoxicity receptor NF-κB Nuclear factor kappa-light-chain-enhancer of activated B cells NK Natural killer NKp44 Natural cytotoxicity receptor 44 NKR-P1A Natural killer receptor protein 1A oligo Oligoarticular p Probability P/S/glu Penicillin/streptomycin/glutamine PAMPs Pathogen-associated molecular patterns 6 PB Peripheral blood PBMC Peripheral blood mononuclear cells PBS Phosphate buffered saline PCR Polymerase chain reaction pDC Plasmacytoid DC PE R-phycoerythrin PerCP Peridinin chlorophyll protein PMA Phorbol myristate acetate poly Polyarticular PRR Pattern recognition receptors PsA Psoriatic RA Retinoic acid RALDH Retinaldehyde dehydrogenase RAR Retinoic acid receptor RF Rheumatoid factor rh Recombinant human RORC Retinoic acid-related orphan nuclear hormone receptor C SF Synovial fluid SFMC Synovial fluid mononuclear cells SNP Single nucleotide polymorphisms SpA Spondyloarthritis STAT Signal transducer and activation of transcription T conv Conventional T cells T-bet T-box expressed in T cells TCR T cell receptor TE Tris-EDTA TGF Transforming growth factor Th T helper cell TLR Toll-like receptor TNF Tumour necrosis factor Treg Regulatory T cells TSDR Treg-specific demethylated region TSLP Thymic stromal lymphopoietin 7 UCLH University College Hospital London V Variable segment encoding TCR chain 8 Table of Contents Declaration ........................................................................................................ 2 Abstract ............................................................................................................. 3 Acknowledgements .......................................................................................... 4 Abbreviations .................................................................................................... 5 Table of Contents .............................................................................................. 9 List of Tables ................................................................................................... 13 List of Figures ................................................................................................. 14 1 : Introduction ............................................................................................ 18 1.1 Juvenile Idiopathic Arthritis .......................................................................... 19 1.1.1 Definition of Juvenile Idiopathic Arthritis (JIA) ............................................ 19 1.1.1.1 Classification of Enthesitis Related Arthritis (ERA JIA) ................................... 19 1.1.2 Pathogenesis of JIA ................................................................................... 21 1.1.2.1 Genetic associations ....................................................................................... 21 1.1.2.2 Immunopathology of JIA .................................................................................. 22 1.1.2.3 Pathogenesis of ERA JIA ................................................................................ 25 1.1.2.3.1 HLA-B27 mediated immunopathology of ERA JIA ................................... 25 1.1.2.3.2 Immune pathology of ERA JIA ................................................................. 26 1.1.2.3.3 Pathogenesis of adult spondyloarthropathies ........................................... 27 1.1.3 Current strategies for the treatment of JIA ................................................