The presence of dominant T-cell clones in peripheral blood of patients with collagen vascular disorders: a prospective study of 97 cases.
BACKGROUND
T-lymphocyte dysfunction has been seldom investigated in collagen vascular disorders. The search for dominant T-cell clones has been scarcely reported, although the presence of such clones might be expected in disorders showing immune responses directed against a variety of autoantigens.


OBJECTIVE
We conducted a systematic search for dominant T-cell clones in peripheral blood in patients with collagen vascular disorders. Patients and methods Ninety-seven patients with collagen vascular disorders were studied (7 cutaneous and 38 systemic lupus erythematosus; 8 multiple morphea; 12 regional scleroderma; 32 systemic sclerosis of the CREST type). A dominant T-cell clone was searched for in peripheral blood by polymerase chain reaction targeting the T-cell receptor gamma chain followed by a size analysis of amplified fragments. Peripheral blood from patients with nonlymphocyte-dependent disorders and matched by age and sex was assessed in the same conditions. Results in both groups were compared using nonparametric statistical tests.


RESULTS
Overall, a circulating dominant T-cell clone was found in 52% of patients compared with 16.9% in controls. More precisely, such a dominant clone was present in 43% and 37% of cutaneous and systemic lupus erythematosus, respectively, in 75% of multiple morphea, 75% of regional scleroderma and 60% of CREST syndrome patients. The percentages in all subsets of patients were significantly higher than in the control group.


CONCLUSIONS
The presence of a dominant T-cell clone in peripheral blood is significantly more frequent in collagen vascular disorders than in controls, especially in patients with scleroderma, whatever the clinical subset, which suggests T-cell involvement in the immune response dysfunction in these diseases classically characterized by disturbances of B lymphocytes. The relevance of such a dominant clone regarding diagnosis, pathomechanisms, long-term outcome and visceral prognosis of these diseases as well as therapeutic decisions remains to be evaluated.
Dereure
O
O
Department of Dermatology, University Hospital of Montpellier, France. o-dereure@chu-montpellier.fr
Gubler
B
B
Bessis
D
D
Guillot
B
B
Guilhou
J-J
JJ
Clot
J
J
Eliaou
J-F
JF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000276:immunology*; D017675:CREST Syndrome / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D002999:Clone Cells / Q000276:immunology; D003240:Connective Tissue Diseases / Q000276:immunology*; D005260:Female; D006801:Humans; D008178:Lupus Erythematosus, Cutaneous / Q000276:immunology; D008180:Lupus Erythematosus, Systemic / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016692:Receptors, Antigen, T-Cell, gamma-delta / Q000235:genetics; D012594:Scleroderma, Localized / Q000276:immunology; D012595:Scleroderma, Systemic / Q000276:immunology; D013601:T-Lymphocytes / Q000276:immunology*
D016692:Receptors, Antigen, T-Cell, gamma-delta